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DOI: 10.1055/a-1241-4489
Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents
Article in several languages: English | deutschAbstract
Background Primary open-angle glaucoma (POAG) is still one of the most common causes of impaired vision worldwide, despite the further development of therapy options, and can lead to blindness. Micro-invasive glaucoma surgery (MIGS) using stents aims at reducing intraocular pressure (IOP), as it is the main risk factor. With regard to adherence and adverse drug reactions it also aims at reducing the drug burden on patients. The study investigates under everyday conditions the criteria according to which ophthalmologists in Germany select patients for MIGS using stents. In addition, it will be investigated which patients (could) benefit most from the therapy.
Material and Methods In this qualitative study, 11 narrative interviews were conducted between May 2017 and July 2018 with ophthalmologists working in the hospital or in a private practice. They were interviewed on their experiences in the treatment of POAG with microstents. The interviews were analysed by an interdisciplinary team using the qualitative content analysis.
Results The stages of therapy escalation form the frame of reference for patient selection in MIGS using stents. Only if the IOP cannot be sufficiently reduced by drop therapy or when this causes drug-related side effects that are intolerable for the patients, stents are apparently used as the next higher escalation stage. The intensive post-operative medication and the frequent check-up appointments are perceived as barriers by the interviewees, especially for people with or without disabilities, who are dependent on external help and/or those living in rural areas. The active cooperation of the patients in the demanding aftercare seems to be indispensable for the ophthalmologists. In addition, necessary revisions are sometimes stressful for patients (physical/psychological) and doctors (work organisation/therapy). Against the background of the organisational and economic challenges in the outpatient spectrum of tasks, especially physicians in private practice seem to weigh up carefully for which patients microstent therapy would be reasonable.
Conclusion In view of the therapeutic requirements, the current microstent therapy seems to be used in a selected, adherent patient group. Further qualitative and quantitative studies (in other health care regions and structures) are necessary to verify and extend the available results.
Key words
primary open-angle glaucoma - micro-invasive glaucoma surgery - MIGS - microstents - health services research - patient selectionPublication History
Received: 28 April 2020
Accepted: 10 August 2020
Article published online:
30 November 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References/Literatur
- 1 Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96: 614-618 doi:10.1136/bjophthalmol-2011-300539
- 2 Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006; 90: 262-267 doi:10.1136/bjo.2005.081224
- 3 Tham YC, Li X, Wong TY. et al. Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis. Ophthalmology 2014; 121: 2081-2090 doi:10.1016/j.ophtha.2014.11.030
- 4 Höhn R, Nickels S, Schuster AK. et al. Prevalence of glaucoma in Germany: results from the Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol 2018; 256: 1695-1702 doi:10.1007/s00417-018-4011-z
- 5 Frech S, Kreft D, Guthoff RF. et al. Pharmacoepidemiological assessment of adherence and influencing co-factors among primary open-angle glaucoma patients – An observational cohort study. PLoS One 2018; 13: e0191185 doi:10.1371/journal.pone.0191185
- 6 Heijl A, Leske MC, Bengtsson B. et al. Reduction of Intraocular Pressure and Glaucoma Progression: Results From the Early Manifest Glaucoma Trial. Arch Ophthalmol 2002; 120: 1268-1279 doi:10.1001/archopht.120.10.1268
- 7 Rhee DJ. Primäres Offenwinkelglaukom (August 2017). Available at (accessed 14.06.2020): https://www.msdmanuals.com/de-de/profi/augenkrankheiten/glaukom/prim%25C3%25A4res-offenwinkelglaukom
- 8 Boland MV, Ervin AM, Friedman DS. et al. Comparative Effectiveness of Treatments for Open-Angle Glaucoma: A Systematic Review for the U. S. Preventive Services Task Force. Ann Intern Med 2013; 158: 271-279 doi:10.7326/0003-4819-158-4-201302190-00008
- 9 Conlon R, Saheb H, Ahmed IIK. Glaucoma treatment trends: a review. Can J Ophthalmol 2017; 52: 114-124 doi:10.1016/j.jcjo.2016.07.013
- 10 World Health Organization. Adherence to long-term Therapies: Evidence for Action. Geneva: World Health Organization; 2003. Available at (accessed 14.06.2020): https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf
- 11 Tsai JC, McClure CA, Ramos SE. et al. Compliance barriers in glaucoma: a systematic classification. J Glaucoma 2003; 12: 393-398 doi:10.1097/00061198-200310000-00001
- 12 Dietlein TS, Rosentreter A, Lappas A. Umsetzung und Schwierigkeiten bei Tropftherapien – der ältere Glaukompatient im Fokus. Klin Monbl Augenheilkd 2016; 233: 138-142 doi:10.1055/s-0041-110447
- 13 Yook E, Vinod K, Panarelli JF. Complications of micro-invasive glaucoma surgery. Curr Opin Ophthalmol 2018; 29: 147-154 doi:10.1097/ICU.0000000000000457
- 14 Manasses DT, Au L. The New Era of Glaucoma Micro-stent Surgery. Ophthalmol Ther 2016; 5: 135-146 doi:10.1007/s40123-016-0054-6
- 15 Jünemann AGM, Rejdak R, Hohberger B. Trabekuläre mikroinvasive Glaukomchirurgie: Verfahren und klinische Ergebnisse. Ophthalmologe 2018; 115: 363-369 doi:10.1007/s00347-018-0689-x
- 16 Ahmed IIK, Fea A, Au L. et al. A prospective randomized trial comparing Hydrus and iStent micro-invasive glaucoma surgery implants for standalone treatment of open-angle glaucoma: The COMPARE Study. Ophthalmology 2019; 127: 52-61 doi:10.1016/j.ophtha.2019.04.034
- 17 Lavia C, Dallorto L, Maule M. et al. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. PLoS One 2017; 12: e0183142 doi:10.1371/journal.pone.0183142
- 18 Agrawal P, Bradshaw SE. Systematic Literature Review of Clinical and Economic Outcomes of Micro-Invasive Glaucoma Surgery (MIGS) in Primary Open-Angle Glaucoma. Ophthalmol Ther 2018; 7: 49-73 doi:10.1007/s40123-018-0131-0
- 19 Canadian Agency for Drugs and Technologies in Health (CADTH). Optimal use of minimally invasive Glaucoma Surgery: a Health Technology Assessment. Ottawa: CADTH; 2019. Available at (accessed 14.06.2020): https://www.ncbi.nlm.nih.gov/books/NBK543901/pdf/Bookshelf_NBK543901.pdf
- 20 Jones RK, Jefferis JM. Is qualitative research under-represented in ophthalmology journals?. Eye (Lond) 2017; 31: 1117-1119 doi:10.1038/eye.2017.49
- 21 Prior M, Francis JJ, Azuara-Blanco A. et al. Why do people present late with advanced glaucoma? A qualitative interview study. Br J Ophthalmol 2013; 97: 1574-1578 doi:10.1136/bjophthalmol-2013-303813
- 22 Lacey J, Cate H, Broadway DC. Barriers to adherence with glaucoma medications: a qualitative research study. Eye (Lond) 2009; 23: 924-932 doi:10.1038/eye.2008.103
- 23 Kerr NM, Wang J, Barton K. Minimally invasive glaucoma surgery as primary stand-alone surgery for glaucoma. Clin Experiment Ophthalmol 2017; 45: 393-400 doi:10.1111/ceo.12888
- 24 Meyer T, Karbach U, Holmberg C. et al. Qualitative Studien in der Versorgungsforschung – Diskussionspapier, Teil 1: Gegenstandsbestimmung. Gesundheitswesen 2012; 74: 510-515 doi:10.1055/s-0032-1323693
- 25 Karbach U, Stamer M, Holmberg C. et al. Qualitative Studien in der Versorgungsforschung – Diskussionspapier, Teil 2: Stand qualitativer Versorgungsforschung in Deutschland – ein exemplarischer Überblick. Gesundheitswesen 2012; 74: 516-525 doi:10.1055/s-0032-1323694
- 26 Stamer M, Güthlin C, Holmberg C. et al. Qualitative Studien in der Versorgungsforschung – Diskussionspapier, Teil 3: Qualität qualitativer Studien. Gesundheitswesen 2015; 77: 966-975 doi:10.1055/s-0035-1565235
- 27 Schütze F. Biographieforschung und narratives Interview. Neue Prax 1983; 13: 283-293
- 28 Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken. 10. Aufl.. Weinheim: Beltz; 2008
- 29 Liebig S, Gebel T, Grenzer M. et al. Datenschutzrechtliche Anforderungen bei der Generierung und Archivierung qualitativer Interviewdaten. 2014 Available at (accessed 14.06.2020): https://www.ratswd.de/dl/RatSWD_WP_238.pdf
- 30 Siewert S, Pfensig S, Großmann S. et al. Development of a drug-eluting microstent for micro-invasive glaucoma surgery. Curr Dir Biomed Eng 2018; 4: 603-606 doi:10.1515/cdbme-2018-0145