Characteristics and Treatment Patterns of Newly Diagnosed Open-Angle Glaucoma Patients in the US: An Administrative Database Analysis.

Abstract Purpose To characterize newly diagnosed primary open-angle glaucoma (OAG) patients and describe their treatment journey in US clinical practice according to the utilization of topical therapy, laser trabeculoplasty, and surgical procedures. Design Retrospective claims database study. Subjects, Participants and/or Controls Patients with at least 2 diagnoses of OAG ≥7 days apart and within 1 year, with the first (index) diagnosis in 2010, at least 30 months of continuous enrollment pre-index diagnosis with no OAG diagnosis or medication (exception for ocular hypertension diagnosis), and 48 months of continuous enrollment. Methods, Intervention or Testing Analysis of US healthcare insurance claims database (July 2007 to December 2014). Main Outcome Measures Treatment patterns and ophthalmology visits were evaluated over 48 months in 4 cohorts based on initial therapy after the index diagnosis: i) drug monotherapy, ii) combination drug therapy, iii) glaucoma procedure, or iv) no claims for treatment. Treatment modification was defined as an addition to or change in drug therapy or procedure. Results In total, 83.0% (5120/6172) of patients were initiated on drug (69.5%) or procedure (13.5%): topical prostaglandin analogs (n=2887/5120 [56.4%]) and laser trabeculoplasty (n=705/5120 [13.8%]) were the most common. During 4-year follow-up, 58.3% (2109/3620) of patients initiated on drug monotherapy experienced no further treatment modification. Over this period, 43.8% of patients initiating treatment (2,242/5120) experienced a treatment modification to the first treatment. Two-thirds (1505/2242; 67.1%) of these patients subsequently had a third treatment modification. Ophthalmology visits declined over time regardless of initial therapy, with the greatest decrease among the untreated and first-treatment procedure cohorts. Conclusions The high rates of 2 or 3 treatment modifications over the 4-year period suggest an unmet need for glaucoma therapies with durable and predictable actions.