Clinical Outcomes of Glaucoma Treatments Over a Patient Lifetime: A Markov Model

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Purpose:To quantify the clinical outcome of glaucoma treatment over a patient's lifetime to identify treatment parameters that would preserve vision across a population.Methods:A Markov model was used to reproduce glaucoma treatments and clinical responses over a patient's lifetime. Markov states comprised first-line to fourth-line pharmacological treatments, no treatment, laser therapy, surgery, blindness, and death. All patients began with first-line treatment and passed to the next treatment in line following a failure. After each failure, and always after a fourth-line failure, patients could receive laser therapy or surgery, followed by no treatment or a new first-line treatment. Transitional probabilities came from a cross-sectional study and national statistics. Sensitivity analyses were based on second order Monte-Carlo simulation.Results:Cohort demographics were average age 59.7 years, life expectancy 22.5 years, females 54.0%. Treatment durations (months) for a patient with ocular hypertension were first-line (89), second-line (49), third-line (41), and no treatment (44); laser interventions numbered 1.251 and surgical 0.882. For a patient with glaucoma the corresponding values were 70, 44, 40, 18, 42, 1.197, and 0.842. First-line or second-line drugs best at controlling intraocular pressure (IOP) reduced laser therapy, surgery, and the prevalence of blindness. The most effective drug should be prescribed first-line. According to our model drugs specifically able to arrest disease progression would be more beneficial than intraocular pressure control.Conclusion:More powerful glaucoma medication (first-line or second-line) would contribute to the preservation of long-term vision.

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