Clinical Evaluation of Unilateral Open-Angle Glaucoma: A Two-Year Follow-Up Study

Inter-eye correlation analysis of 24-h IOPs and glaucoma progression

Purpose

To determine whether 24-h IOP monitoring can be a predictor for glaucoma progression and to analyze the inter-eye relationship of IOP, perfusion, and progression parameters.

Methods

We extracted data from manually drawn IOP curves with HIOP-Reader, a software suite we developed. The relationship between measured IOPs and mean ocular perfusion pressures (MOPP) to retinal nerve fiber layer (RNFL) thickness was analyzed. We determined the ROC curves for peak IOP (T_max), average IOP(T_avg), IOP variation (IOP_var), and historical IOP cut-off levels to detect glaucoma progression (rate of RNFL loss). Bivariate analysis was also conducted to check for various inter-eye relationships.

Results

Two hundred seventeen eyes were included. The average IOP was 14.8 ± 3.5 mmHg, with a 24-h variation of 5.2 ± 2.9 mmHg. A total of 52% of eyes with RNFL progression data showed disease progression. There was no significant difference in T_max, T_avg, and IOP_var between progressors and non-progressors (all p > 0.05). Except for T_avg and the temporal RNFL, there was no correlation between disease progression in any quadrant and T_max, T_avg, and IOP_var. Twenty-four-hour and outpatient IOP variables had poor sensitivities and specificities in detecting disease progression. The correlation of inter-eye parameters was moderate; correlation with disease progression was weak.

Conclusion

In line with our previous study, IOP data obtained during a single visit (outpatient or inpatient monitoring) make for a poor diagnostic tool, no matter the method deployed. Glaucoma progression and perfusion pressure in left and right eyes correlated weakly to moderately with each other.

Cost effectiveness analysis associated to the treatment of primary open-angle glaucoma according to disease severity

Introduction/Objective. POAG treatment should be individually tailored to the disease severity and type, effectiveness and secondary side effects of the medications used. This research aimed to assess the direct medical costs and the cost effectiveness associated with pharmacotherapy in visually impaired people with primary open-angle glaucoma according to disease severity. Methods. This scientific study is designed as an observational cross-sectional study with a quantitative analytical approach and was conducted in the period from July 2020 to June 2021 on the territory of North Macedonia. The study included 157 patients with binocular POAG in the early, moderate and advanced clinical stage, up to the age of 67, with changes in visual acuity and work ability. During the assessment of the effects of pharmacotherapy were analyzed the types, mutual correlations and effectiveness of the most commonly prescribed antiglaucomatous medications and the cost benefit from their administration. Direct medical costs are calculated according to disease severity in the last 12 months using real-time data of public interest. Results. The beta blockers due to their affordable price and availability are the dominant option with high-cost benefit for primary treatment of POAG. Antiglaucoma medications and diagnostic procedures are major components of direct medical treatment costs. Conclusion. Pharmacotherapy is the dominant alternative compared to other types of treatment because it is safer and is associated with greater effictiveness and lower direct medical costs.