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Related Experiment Videos

Applying the recent clinical trials on primary open angle glaucoma: the developing world perspective.

Ravi Thomas1, Rajesh S Kumar, G Chandrasekhar

  • 1L.V. Prasad Eye Institute, L.V. Prasad Marg Banjara Hills, Hyderabad, India. ravithomas@lvpei.org

Journal of Glaucoma
|July 2, 2005
PubMed
Summary

Tailoring glaucoma treatment using Number Needed to Treat (NNT) improves cost-effectiveness in developing nations. Primary open-angle glaucoma (POAG) may warrant public health focus, but implementation faces challenges.

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Area of Science:

  • Ophthalmology
  • Public Health
  • Health Economics

Background:

  • Clinical trials offer guidelines for treating ocular hypertension and primary open-angle glaucoma (POAG).
  • Developing countries require cost-effective application of these treatment guidelines.
  • Number Needed to Treat (NNT) and Population Attributable Risk (PAR) are key metrics.

Purpose of the Study:

  • To assess the cost-effectiveness of current glaucoma treatment guidelines in developing countries.
  • To determine the public health significance of ocular hypertension and POAG.
  • To evaluate treatment strategies, including primary surgery, for resource-limited settings.

Main Methods:

  • Analysis of Number Needed to Treat (NNT) for ocular hypertension and POAG based on patient risk factors.

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  • Calculation of Population Attributable Risk (PAR) to gauge public health impact.
  • Consideration of treatment modalities like surgery, referencing the Collaborative Initial Glaucoma Treatment Study (CIGTS).

    • Main Results:

    • NNT for ocular hypertension is 20, reduced to 6 for those with intraocular pressure >= 26 mm Hg.
    • NNT for early POAG is 5, further reduced by targeting high-risk individuals.
    • Ocular hypertension has an effective PAR of 8.5%; POAG has an effective PAR of 16%.

    Conclusions:

    • Targeting high-risk patients significantly lowers NNT, enhancing cost-effectiveness for glaucoma treatment.
    • POAG's PAR suggests public health importance, but logistical and economic factors hinder its inclusion in developing country health budgets.
    • Primary surgery, if quality assured, may be viable in developing countries, as suggested by CIGTS findings.