title: Medical decision, persistence of initial treatment, and glaucoma progression in a Brazilian reference hospital.
abstract: OBJECTIVE
  To evaluate the initial medical decision regarding primary open-angle glaucoma (POAG) treatment in a referral center, and to assess the relationship between the persistence of treatment and the disease progression in cases managed exclusively with medication.
  
  
  METHODS
  A retrospective chart review was performed for 65 patients with primary open-angle glaucoma referred to a tertiary hospital. The following clinical data were analyzed: initial medication, persistence of treatment, best corrected visual acuity, visual field mean deviation index, cup/disc ratio, and intraocular pressure. Patients were classified into four categories in order to verify the clinical evolution.
  
  
  RESULTS
  The mean number of visits/ year was 4.4 +/- 3.5, and the follow-up period was 40.7 +/- 22.8 months. Mean persistence time was 12.9 +/- 13.9 months. By six and twelve months, respectively, 39.1% and 62.5% of patients had discontinued the initially prescribed regimen, mainly by adding to (42%) or changing (26%) the course of treatment. Thirteen patients (21%) were reclassified to a worse category of primary open-angle glaucoma, however, despite this trend, no significant correlation was found between shorter persistence and primary open-angle glaucoma worsening.
  
  
  CONCLUSIONS
  Persistence rates with initial therapy schemes were low, as measured by medical decisions to change the course of treatment. Therefore, improvement in the initial medical decision is crucial in order to offer a more stable and effective treatment for primary open-angle glaucoma.
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil. jspaula@fmrp.usp.br
authors.forename: Jayter Silva
authors.initials: JS
authors.lastname: Paula
authors.forename: José Afonso
authors.initials: JA
authors.lastname: Ramos Filho
authors.forename: Daniel Felipe Alves
authors.initials: DF
authors.lastname: Cecchetti
authors.forename: Daniela Tiemi
authors.initials: DT
authors.lastname: Nagatsuyu
authors.forename: Maria de Lourdes Veronese
authors.initials: Mde L
authors.lastname: Rodrigues
authors.forename: Eduardo Melani
authors.initials: EM
authors.lastname: Rocha
mesh_terms: D000368:Aged; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity; D014794:Visual Fields