title: Criteria for choosing clinically effective glaucoma treatment: A discussion panel consensus.
abstract: Abstract.
  
  
  BACKGROUND
  In the clinical management of patients at risk for or diagnosed with primary open-angle glaucoma (POAG), the aim of medical treatment is to reduce intraocular pressure (IOP) and then maintain it over time at a level that preserves both the structure and function of the optic nerve.
  
  
  OBJECTIVE
  The objective of this report was to establish a consensus on the criteria that should be used to determine the characteristics of IOP-lowering medication.
  
  
  METHODS
  Discussion was held among a panel of 12 physicians considered to be experts in glaucoma to develop a consensus on the criteria used by them to determine the characteristics of the IOP-lowering medication chosen for initial monotherapy and adjunctive treatment of ocular hypertension (OHT) or POAG. Consensus development combined available evidence and the impressions of these physicians regarding the clinical effectiveness of IOP-lowering medication for OHT and POAG. Once the panel identified the criteria, the order of priority and the relative importance of these criteria were then established in the setting of 3 risk categories (low, medium, and high) for a patient to experience significant visual disability from glaucoma over their expected life span.
  
  
  RESULTS
  The panel identified 5 criteria to determine the characteristics of IOP-lowering medication for OHT and POAG: IOP-lowering effect, systemic adverse events (AEs), ocular tolerability, compliance/administration, and cost of treatment. IOP-lowering effect was consistently ranked as the highest priority and cost as the lowest. The priority of compliance/administration did not vary by clinical situation. Systemic AEs and ocular tolerability were ranked as higher priorities in initial monotherapy than in adjunctive treatment and ranked lower as the risk for visual disability increased. The priority given to the criteria used to determine clinical effectiveness varied both with the risk for functional vision loss from glaucoma and whether initial monotherapy or adjunctive treatment was being considered.
  
  
  CONCLUSIONS
  Glaucoma treatment should be assessed with regard to the need not only to lower IOP but also to minimize systemic and ocular AEs, promote patient compliance, and minimize cost. The order of priority and relative importance given to these treatment criteria will vary as part of individualizing patient care.
authors.affiliation: Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Thygesen
authors.affiliation: Department of Ophthalmology, Academic Hospital Bielefeld, Bielefeld, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Burk
authors.affiliation: Department of Ophthalmology and Visual Sciences, San Raffaele Hospital, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Carassa
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Crichton
authors.affiliation: Institut de Microcirurgia Ocular (IMO), Universidad Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Goñi
authors.affiliation: Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Mitch
authors.initials: M
authors.lastname: Menage
authors.affiliation: University of Milan Bicocca, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Miglior
authors.affiliation: Eye Department, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Donald
authors.initials: D
authors.lastname: Montgomery
authors.affiliation: Centre Hospitalier des Quinze-Vingts, Paris, France.
authors.forename: John-Philippe
authors.initials: JP
authors.lastname: Nordmann
authors.affiliation: Department of Ophthalmology, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Roberts
authors.affiliation: Department of Ophthalmology, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Kuldev
authors.initials: K
authors.lastname: Singh
keywords: consensus; criteria; glaucoma; intraocular pressure