Primary open-angle glaucoma sometimes undertreated, RAND study finds

Patients with primary open-angle glaucoma generally receive care consistent with published preferred practices, according to a retrospective review. However, care falls short in several key aspects, researchers said, and primary open-angle glaucoma may be undertreated relative to standards for intraocular pressure control established in recent clinical trials.

Allen Fremont, MD, PhD, and colleagues with California’s RAND Health Program and other research facilities reviewed administrative, survey and eye care records of 395 working-age patients with primary open-angle glaucoma (POAG) in six managed care plans over a 2-year period. They compared their findings to the Preferred Practice Pattern for POAG published by the American Academy of Ophthalmology.

High rates of performance were found on most recommended processes during initial evaluations, the researchers said. However, only 53% of patients had an optic nerve head photograph or drawing, and only 1% had a target IOP level documented. Recommended processes were performed at 80% to 97% of follow-up visits. IOP was controlled in 66% of follow-up visits for patients with mild glaucoma. Patients with moderate to severe glaucoma had their glaucoma controlled at 52% of visits.

Adjustments in therapy were more likely with worse IOP control, although adjustments occurred in only half of visits where the IOP was 30 mm Hg or higher, the researchers found.

The analysis is published in the June issue of Archives of Ophthalmology.