[Glaucoma and ocular hypertension: the importance of intraocular pressure in treatment decisions in France].
OBJECTIVE
Several recent clinical studies have shown the benefit of lowering intraocular pressure in both ocular hypertensive and glaucoma patients. However, in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT), there is no consensus on the value of intraocular pressure (IOP) to be reached to prevent the progression of visual field defects. This IOP value, called target IOP, is defined by the ophthalmologist according to the patient and the progression of the disease, without a clear explicit justification of this decision. In France, ophthalmologists' education is mainly based on scientific meetings and the European Guidelines. This study was conducted to investigate the position of the IOP target in the treatment strategy for patients with glaucoma or OHT.


METHODS
and methods: A cross-sectional descriptive survey was conducted in France among ophthalmologists in private practice. Patients with simple OHT or with OAG who required an initiation or a modification of treatment were included.


RESULTS
We included 1735 patients (805 males, 46.4%) in the study. An OAG was diagnosed in 1338 patients (77.1%) and a simple OHT in 397 patients (22.9%). The patients with OAG were older than the OHT patients (65 years vs 61.7 years, p<0.0001). Most patients (73.5%) were included for treatment modification (77.5% of the patients with OAG and 59.9% of the patients with simple OHT; p<0.0001). The main reason for treatment change was an unsatisfactory IOP value. The main therapeutic objective was to reach a target IOP in 46.0% of the patients. The choice of the ocular hypotensive drugs depended on the IOP value in 51.9% of the patients. When the treatment was modified, monotherapy was preferred in 60.8% of the patients.


CONCLUSIONS
Among ophthalmologists, the main objective for the treatment of patients with simple OHT or with OAG was to reach a target IOP. About half the participants were used to set up a target pressure for their patients. This fairly good ratio shows the comprehensiveness and the adaptation of our colleagues to relatively new concepts in treating and managing patients with ocular hypertension or chronic open-angle glaucoma. If a modification in the treatment was necessary, then monotherapy was preferred. This decision was motivated by the efficacy of the treatment but also by expected better patient compliance.
Bron
A
A
Service d'Ophtalmologie, CHU Hôpital Général, 21000 Dijon. Alain.bron@chu-dijon.fr
Nordmann
J-P
JP
Baudouin
C
C
Rouland
J-F
JF
Kadi
A
A
Sartral
M
M
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003657:Decision Making; D018450:Disease Progression; D016903:Drug Monitoring; D005260:Female; D005602:France; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D009885:Ophthalmology / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000523:psychology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011331:Private Practice; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014794:Visual Fields