Treatment of glaucoma patients with insufficient intraocular pressure control: a survey of German ophthalmologists in private practice.
OBJECTIVE
To assess the degree to which glaucoma treatment guidelines have been incorporated into daily practices and to describe the therapeutic practices chosen for patients with insufficient intraocular pressure (IOP) control.


METHODS
Ophthalmologists in private practice in Germany were surveyed to obtain information about patients who exhibited unsatisfactory progress with IOP-lowering pharmacotherapy. Using a questionnaire, physicians provided data concerning treatment difficulty, target IOP, number and type of medications used, two most recent IOP readings, and optic nerve head and visual field observations.


RESULTS
Of the 853 patients analyzed, primary open-angle glaucoma was the diagnosis for 67.1%, and other diagnoses included ocular hypertension, normal tension glaucoma, and pseudoexfoliation glaucoma. Target IOP levels had been determined for 95.5% of patients, and not achieving the target pressure was identified as a treatment difficulty for 81.0% of patients. Of patients on monotherapy, beta-blockers were prescribed most often (42.3%). Of all patients, 53.3% were treated with two or more agents as either fixed or non-fixed combinations. The non-fixed combination of a prostaglandin and carbonic anhydrase inhibitor was the most frequently prescribed dual therapy (19.2%). Non-fixed prostaglandin plus beta-blocker was used by 18.0% of dual therapy patients, whereas the available fixed combination was used by 10.5%. Non-compliance was identified as a cause of unsatisfactory IOP-lowering in 26.8% of all patients. This study is limited by its descriptive, non-interventional design.


CONCLUSIONS
Treatment alterations are necessary to achieve sufficient IOP control in some patients. If these patients were to take advantage of more aggressive therapies as outlined by treatment guidelines, including newer formulations and fixed combination preparations, both efficacy and compliance may be improved.
Vorwerk
Christian
C
Augenklinik der Otto von Guericke Universität Magdeburg, Magdeburg, Germany.
Thelen
Ulrich
U
Buchholz
Patricia
P
Kimmich
Friedemann
F
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011331:Private Practice; D011379:Prognosis; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage*; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014065:Tonometry, Ocular; D017211:Treatment Failure
D000319:Adrenergic beta-Antagonists; D011461:Prostaglandins F, Synthetic