Clinical outcomes of glaucoma treatments over a patient lifetime: a Markov model.
OBJECTIVE
To quantify the clinical outcome of glaucoma treatment over a patient's lifetime to identify treatment parameters that would preserve vision across a population.


METHODS
A Markov model was used to reproduce glaucoma treatments and clinical responses over a patient's lifetime. Markov states comprised first-line to fourth-line pharmacological treatments, no treatment, laser therapy, surgery, blindness, and death. All patients began with first-line treatment and passed to the next treatment in line following a failure. After each failure, and always after a fourth-line failure, patients could receive laser therapy or surgery, followed by no treatment or a new first-line treatment. Transitional probabilities came from a cross-sectional study and national statistics. Sensitivity analyses were based on second order Monte-Carlo simulation.


RESULTS
Cohort demographics were average age 59.7 years, life expectancy 22.5 years, females 54.0%. Treatment durations (months) for a patient with ocular hypertension were first-line (89), second-line (49), third-line (41), and no treatment (44); laser interventions numbered 1.251 and surgical 0.882. For a patient with glaucoma the corresponding values were 70, 44, 40, 18, 42, 1.197, and 0.842. First-line or second-line drugs best at controlling intraocular pressure (IOP) reduced laser therapy, surgery, and the prevalence of blindness. The most effective drug should be prescribed first-line. According to our model drugs specifically able to arrest disease progression would be more beneficial than intraocular pressure control.


CONCLUSIONS
More powerful glaucoma medication (first-line or second-line) would contribute to the preservation of long-term vision.
Nordmann
Jean Philippe
JP
Hôpital des Quinze-Vingts, Centre Hospitalier National d'Ophtalmologie, Paris, France.
Lafuma
Antoine
A
Deschaseaux
Céline
C
Berdeaux
Gilles
G
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001766:Blindness / Q000503:physiopathology; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D053685:Laser Therapy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D009010:Monte Carlo Method; D009798:Ocular Hypertension / Q000503:physiopathology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012607:Scotoma / Q000503:physiopathology; D012680:Sensitivity and Specificity; D014130:Trabeculectomy / Q000379:methods; D014794:Visual Fields
D000959:Antihypertensive Agents