Disease Management Programs for Glaucoma: Has the Vision Become a Reality?
Lawrence D. Goldberg
Glaucoma is a family of diseases characterized by optic neuropathy that leads to vision loss and blindness. Glaucoma affects approximately 2.5 million people in the US and is expected to increase to 60.5 million people worldwide by 2010. The annual costs of glaucoma are significant, with costs to the US government estimated to be $US1.5 billion. Elevated intraocular pressure (IOP) is the most recognized risk factor for glaucoma, followed by advanced age, race, and family history. Results from randomized controlled trials have indicated that treatments that reduce IOP may result in benefits for glaucoma management. The increasing prevalence of this disease, the costs associated with undiagnosed and untreated glaucoma, and the availability of cost-effective treatment that can help prevent development and worsening severity of the disease suggest that disease management (DM) programs for glaucoma should be developed and used to improve both clinical and economic outcomes. Evidence-based clinical practice guidelines that have been developed worldwide agree that there is a need for detection of high-risk individuals; however, these guidelines differ in their recommendations for screening because there is no single test that is able to perfectly discriminate between individuals with and without open-angle glaucoma. Furthermore, the most cost-effective screening protocol for glaucoma has yet to be determined. In the US, Medicare reimbursement is available for glaucoma screening in high-risk individuals, and a Health Plan Employer Data and Information Set (HEDIS) Glaucoma Screening Measure has been implemented for glaucoma screening of Medicare-eligible individuals. Progress in the adoption of DM programs for glaucoma treatment has been slow, primarily because of the need for multiple tests to definitively diagnose glaucoma and the associated costs involved with implementing such a program. A DM program for glaucoma should include treatment and follow-up as well as screening. Guidelines from the US, Canada, Europe and Asia-Pacific have become increasingly aggressive as the benefits of very low IOP have become recognized; however, they each have different recommendations for target reductions in IOP in treating glaucoma. For optimal clinical and economic outcomes, further research is required to identify cost-effective, accurate screening methods as well as cost-effective treatments that reduce IOP and incorporate these into the care paradigms associated with these programs. The outcomes of such research will help to develop and implement comprehensive DM programs that encompass screening, treatment, and follow-up in glaucoma.
In order to set up a list of libraries that you have access to,
you must first login
or sign up.
Then set up a personal list of libraries from your profile page by
clicking on your user name at the top right of any screen.