Understanding the treatments currently administered for glaucoma, an eye condition where the nerve connecing the eye to the brain is damaged, is challenging because the relevant information being is spread across GP and hospital datasets. Many treatments are available, including eye drops, oral medicines, and surgery, but it's currently unclear for how long a patient is likely to be administered a treatment between being moved to a different one. Lastly, it is recognised some additional conditions, such as severe mental illness or post-stroke partial paralysis, could affect adherence to treatment, in particular for eye drops, but there are no sources in the literature documenting the severity of the issue.
The study aims to describe the steps currently taken in the UK to manage glaucoma, documenting how the condition tends to progress, noting the amount of time patients are spending being treated with each approach, and highlighting of possible drivers for treatment change.
This will benefit the UK population, especially the cohort with glaucoma in addition to other conditions which affect their ability to follow treatment treatment, as it it will expose areas where greater support is required.
Glaucoma management relies on controlling intra-ocular pressure (IOP) to prevent irreversible retinal damage. No treatments can modify the disease process, but IOP control options can delay visual impairment.
Objective of Task 1: to count all patients with glaucoma. While procedures will be reliably documented in secondary care, they may not capture all patients, particularly those in the early stages of the disease.
Objective of Task 2: to describe the treatment progression associated with glaucoma. To capture longitudinally the full treatment sequence from diagnosis to end-stage, a patient cohort needs to be followed up for 10-15 years. Thus, a fractionated retrospective approach is proposed, which involves identifying patients in five cohorts based on codes for blindness, incisional surgery, MIGS, SLT, and topical therapy in the past 5 years. Five separate time to event Kaplan-Meier survival curves will be constructed for each cohort.
Objective of Task 3: to count the number of patients with the 40 comorbidities identified by the literature and by a board of ophthalmologists to potentially affect adherence to topical therapy. To protect confidentiality and ensure the analysis is manageable, we mapped them into 10 categories: low vision; movement disorders, including congenital and degenerative CNS disorders; post stroke impairment and other paralyses; peripheral neuropathies and myopathies, including SLE; arthropathies and injuries affecting upper limbs; degenerative, traumatic and pathological CNS disorders disrupting cognitive function; severe mental illness; substance dependence; intellectual disability; and CNS and mental conditions NOS.
The population of interest for this retrospective cohort study includes all UK glaucoma patients in 2017-2022.
We will use HES Admitted Patient Care and Outpatient, as glaucoma is primarily managed in secondary care, but we will supplement this with CPRD Aurum, as HES data are often incomplete, while GP records will likely include diagnoses originating from hospital appointments and topical therapy prescription information.
Task 1
Total number of people in CPRD and number with qualifying glaucoma code, divided in female/male and 40-54/55-69/70-84/85+ age brackets.
Task 2
Time elapsed between blindness, incisional surgery, MIGS, SLT and topical therapy.
Task 3
Number of people qualifying glaucoma code, divided in female/male and 40-54/55-69/70-84/85+ age brackets, and with a count of how many comorbidities they have for each of the 10 identified categories.
Jonathan Belsey - Chief Investigator - JB Medical Ltd
David Sgorbati - Corresponding Applicant - The Health Economics Unit
Jonathan Belsey - Collaborator - JB Medical Ltd
SANTOSH KUMAR - Collaborator - NHS MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
XIAOXU Zou - Collaborator - The Health Economics Unit
HES Admitted Patient Care;HES Outpatient