Which patients are treated for glaucoma? An observational analysis

Purpose: More than one million patients in the United States are treated fo r glaucoma, although little is known about the typical clinical characteris tics of this group of patients and the type of therapy they receive. This s tudy was conducted to describe the demographic and diagnostic characteristi cs of patients beginning long-term drug therapy for glaucoma. Methods: This cross-sectional study included 544 patients beginning topical glaucoma medication regimens who received care at a group model health-mai ntenance organization (HMO) located in central Massachusetts. The primary m edical records of 544 patients beginning topical glaucoma medication betwee n 1987 and 1990 were reviewed to ascertain the presence of three clinical f indings: intraocular pressure (IOP) greater than or equal to 22 mmHg; optic disc changes including cup-to-disc ratio greater than or equal to 0.8, cup -to-disc asymmetry greater than or equal to 0.2, or morphologic disc change s consistent with glaucomatous optic neuropathy; and visual field defect co nsistent with glaucoma. Results: A majority of the 544 patients (86%) were diagnosed as having prim ary open-angle glaucoma (POAG) by their physicians. Almost half (44.7%) of these patients had only an elevation in IOP without other clinical findings , and 9% met none of the above criteria for glaucoma according to informati on in the medical record. Conclusion: In this setting, most patients who were prescribed drug therapy for POAG were treated for an elevation in IOP alone in the absence of othe r ophthalmologic characteristics of glaucoma.