Use of glaucoma medications: state of the science and directions for observational research.
OBJECTIVE
To summarize observational studies that focus on the use of glaucoma medications and to identify gaps in knowledge to guide future investigation.


METHODS
Literature study.


METHODS
We searched the electronic databases MEDLINE, EMBASE, and PubMed for English language articles published through December 2009 using the search terms physician's practice patterns, drug prescriptions, pharmaceutical services, medication adherence, ophthalmology, glaucoma, and ophthalmic solutions. We categorized studies by areas of focus and extracted and summarized key features: study population, data sources, and main findings.


RESULTS
We identified 2224 articles by the search. Fifty-five described glaucoma medication use using large databases. Predominant areas of focus were: trends in prescription choices (n = 13); adherence, persistence, or both (n = 31); rational use of medications (n = 9); and policy-related issues (n = 2). Over the last decade, use of β-blockers and miotics has decreased substantially, whereas new agents, particularly prostaglandin analogs, have become more popular. Nonadherence was an issue in more than 25% of patients. A significant proportion of patients with comorbidities, contraindications, or both had received topical β-blockers.


CONCLUSIONS
To date, most studies have focused on adherence to glaucoma medications and changes in treatment choices. Major gaps in knowledge include prescribing patterns by prescriber specialty (ophthalmologists, primary care physicians, and optometrists), medication-related problems, and subsequent adverse health outcomes. Well-designed longitudinal observational studies addressing these gaps are warranted to improve patient safety.
Lu
Vicky H
VH
Sydney Eye Hospital, Sydney, New South Wales, Australia.
Goldberg
Ivan
I
Lu
Christine Y
CY
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D009885:Ophthalmology / Q000706:statistics & numerical data*; D010593:Pharmaceutical Services / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016903:Drug Monitoring
D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions