Classification of approaches to primary open-angle glaucoma treatment considering real clinical practice

PURPOSE: To optimize priority treatment regimens using retrospective analysis of treatment approaches in patients with primary open-angle glaucoma (POAG) in routine clinical practice.

METHODS: The final protocols of the combined analytical research and clinical multicenter cohort studies conducted in the period from July 2014 to January 2018 at 30 scientific and clinical bases of 6 (six) countries. 2 223 people;
men — 810, women — 1 413 (2900 eyes), with POAG stages I-III were included in the study. The average age of all patients at the time of inclusion in the study was 64.39±0.64 years. The following indicators were included in the research protocols: the age of patients, the stage of POAG, the time of diagnosis verification, mean deviation (MD) and pattern standard deviation (PSD) at the time of diagnosis verification, treatment regimens, duration
of hypotensive effect and hypotensive efficacy.

RESULTS:Statistically significant differences in the levels of intraocular pressure (IOP) at the time of diagnosis verification in patients with different stages of glaucoma were established: patients with advanced stages of POAG had an IOP level higher than patients with the mild stage of the disease. The average level of IOP at the time of diagnosis verification for mild glaucoma was 26 (24.0; 28.0) mm Hg, for moderate 29 (27.0; 32.0) mm Hg, for advanced 31 (28.0; 34.0) mm Hg. The most commonly used regimens were monotherapies with betablockers (BB) 26.6% and prostaglandin analogues (PG) 24.6%. The combination of these drugs prescribed in 17.9% of cases. Hypotensive efficacy (-5.70 mm Hg) and regimen duration (1.6±0.16 years) of BB monotherapy was weaker than PG monotherapy (-6.35 mm Hg) and (2.16±0.16 years). The antihypertensive efficacy of the combined treatment of PG+BB (-6.56 mm Hg) was comparable to PG monotherapy (-6.35 mm Hg), and the duration of combined therapy was shorter than monotherapy (2.00±0,24 years and 2.16±0.16 years, respectively). Laser treatment provided additional hypotensive effect in combination with local combined therapy. Surgical treatments (STE and NPGS) demonstrated maximum hypotensive efficacy (-11.86 mm Hg and -13.38 mm Hg, respectively). Practitioners begin treatment of POAG with monotherapy at an average age of 62.34±1.1 years and with an average anamnesis of 0.06±0 years. Surgery is performed in younger patients (65.42±1.44 years) with a anamnesis 3.40±0.60 years, the maximal topical hypotensive therapy is used in patients with older age 71.03±2.45 years and a longer anamnesis (4.01±1.07 years) of the disease.

CONCLUSION: The established differences of IOP level at the time of diagnosis verification may be used as a prognostic criterion for POAG. A stepwise approach is most reasonable in patients with POAG. Start with PG, the transition to combination therapy and laser treatment with further surgery will guarantee target IOP and preserve the patient’s visual functions.

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