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Patterns of care for open-angle glaucoma in managed care
Allen M Fremont1, Paul P Lee, Carol M Mangione
1RAND Health Program, Santa Monica, Calif, USA.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|June 11, 2003
Summary
Care for primary open-angle glaucoma (POAG) largely follows guidelines, but key aspects like target intraocular pressure (IOP) documentation and IOP control need improvement for better patient outcomes.
Area of Science:
- Ophthalmology
- Public Health
Background:
- Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
- Adherence to established clinical guidelines is crucial for effective POAG management.
Purpose of the Study:
- To evaluate care patterns for POAG patients.
- To assess adherence to the American Academy of Ophthalmology's Preferred Practice Pattern (PPP).
Main Methods:
- Analysis of administrative, survey, and eye care records for 395 POAG patients (1997-1999).
- Assessment of initial and follow-up visit processes, intraocular pressure (IOP) control, visit intervals, and therapy adjustments.
Main Results:
- High adherence to recommended processes during initial evaluations, but low rates of optic nerve head imaging (53%) and documented target IOP (1%).
- 80-97% adherence to recommended processes during follow-up visits.
- IOP control achieved in 66% of mild POAG and 52% of moderate-to-severe POAG cases; therapy adjustments were infrequent even with high IOP.
Conclusions:
- POAG care generally aligns with PPP recommendations.
- Significant gaps exist in target IOP documentation and achieving optimal IOP control, suggesting potential undertreatment relative to clinical trial standards.