Editors Selection (IGR: 8-3) | International Glaucoma Review #59

Editors Selection IGR 8-3

Patient view

Comment by Paul Lee on:

14065 Views of glaucoma patients on aspects of their treatment: an assessment of patient preference by conjoint analysis, Bhargava JS; Patel B; Foss AJ et al., Investigative Ophthalmology and Visual Science, 2006; 47: 2885-2888

Bhargava et al. (627)extend their innovative and significant work on assessing patient preferences in eye conditions with conjoint analysis to glaucoma therapy choices. In a world increasingly driven by 'patient-centered care' and 'value' from the perspective of patients and payors alike, studies providing insight into what patients expect from their care and understanding what is of greater importance to patients are vital.

Patients rated the risk of being unable to drive the highest in importance (mean of 39%), followed by the risk of blindness (mean of 27%)

In this initial study with patients from consultant outpatient clinics (and thus those with a need to see the highest level care provider for glaucoma), patients were asked to rank a series of ten scenarios (eight derived from the results of a prior study and two validation scenarios) in order of preference. Five factors were used to draw up each scenario: 1) whether topical drop therapy is used; 2) whether trabeculectomy is done; 3) whether there was a 0 or 1% risk of sudden loss of vision due to starting treatment; 4) a 5%, 10%, or 20% risk of not being able to hold an UK driver's license at 10 years; and 5) a 2% or 5% risk of blindness at 10 years. While there can be discussion about the impact of using different factors and numbers (and such would make for worthy additional research), these scenarios present a reasonable set of choices for patients to rank.

Faced with these scenarios, the patients rated the risk of being unable to drive the highest in importance (mean of 39%), followed by the risk of blindness (mean of 27%). The concern of vision loss among these patients echoes the findings of the importance of fear of blindness at diagnosis among patients enrolled in the Collaborative Initial Glaucoma Treatment Study.¹ The distribution of individual patient preferences for blindness and driving issues was not normally distributed, confirming the distributions seen in earlier studies using standard time tradeoff methods among glaucoma patients.²

The issue of what to do with these findings remains. Clearly, older patients are still concerned about vision loss in these results, suggesting that engaging the patient in decision making about the aggressiveness of therapy remains important at all ages. In the seminal work by Jampel,² the large majority of people with glaucoma were not willing to trade off any survival time for perfect vision. By matching the methods of this study with Jampel, we may be able to better identify those persons who are more willing to trade off time for vision preservation and thus move further towards customizing care for each individual's expectations and preferences.

References

Janz NK, Wren PA, Lichter PR, et al. Quality of life in newly diagnosed glaucoma patients: the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 2001; 108 (5): 887-897.
Jampel HD. Glaucoma patients’ assessment of their visual function and quality of life. Trans Am Ophthalmol Soc 2001; 99: 301-317.

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