[An observational, retrospective two-year cost study in primary open-angle glaucoma and ocular hypertension in newly diagnosed patients]. / Etude observationnelle rétrospective de coûts des deux premières années de traitement dans le glaucome primitif à angle ouvert et l'hypertension oculaire en France.

PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.

Differences of retinal nerve fiber layer thickness between normal and glaucoma-like optic disks (physiological cups) matched by optic disk area.

We matched by disk area size 23 eyes of patients with glaucoma-like disks (physiological cups) with normal ocular pressures and no visual field loss with 23 eyes of normal subjects. Using stereophotogrammetry we found a significant decrease in retinal nerve fiber layer thickness in the eyes with glaucoma-like disks compared to the normal eyes (P = 0.0081), especially in the nasal quadrant (18.1%). A similar significant decrease was noted in the neuroretinal rim area and a significant increase in cup volume, area, depth and slope for the total disk and its quadrants. The use of computerized image analysis also showed a significant increase in pallor area for glaucoma-like disks compared to normal disks. Eyes with glaucoma-like disks or physiological cups showed evidence of an optic neuropathy and may be manifesting the same damage to the optic nerve occurring in high pressure open angle glaucoma.