Changes in Medical and Surgical Treatments of Glaucoma between 1997 and 2003 in France

Abstract

To analyze quantitative changes in glaucoma treatment strategies between 1997 and 2003 in France. Numbers of ab externo trabeculectomies and other glaucoma surgeries were extracted from the national database of the French Diagnosis Related Group system, which includes data for both public and private hospitals. Numbers of patients treated per year were estimated from drug unit sales using defined daily doses for each drug. New medical treatments of glaucoma and ocular hypertension, introduced in France between 1997 and 2003, allowed treatment of 557,000 patients. In 2003, 63% of patients treated with these new medicines were receiving prostaglandins (39% latanoprost, 9% travoprost, 8% the fixed combination of latanoprost + timolol, and 7% bimatoprost), 13% brinzolamide, 13% the fixed combination of dorzolamide + timolol, and 11% brimonidine. During the same period, trabeculectomies declined by 38% (-48% in public hospitals and -32% in private clinics), while the total number of glaucoma surgeries declined by 22% (-34% in public hospitals and -14% in private clinics). Hospital days related to open-angle glaucoma surgery declined by 51%. There is a strong correlation (r2=-0.97) between the reduction of glaucoma surgery and the increase in the number of patients treated with prostaglandins during the study period. Between 1997 and 2003, new glaucoma drugs, primarily prostaglandins, improved intraocular pressure control and delayed surgery, reducing glaucoma surgery by 22%.