An assessment of the health and economic burdens of glaucoma

Abstract

Purpose: To bring together information concerning the epidemiology and the economic and individual burdens of glaucoma.

Design: Interpretive essay.

Methods: Review and synthesis of selected literature published from 1991 through December 2010.

Results: An estimated 3% of the global population over 40 years of age currently has glaucoma, the majority of whom are undiagnosed. Vision loss from glaucoma has a significant impact on health-related quality of life even in the early stages of disease. The overall burden increases as glaucomatous damage and vision loss progress. The economic burden of glaucoma is significant and increases as the disease worsens.

Conclusions: Early identification and treatment of patients with glaucoma and those with ocular hypertension at high risk of developing vision loss are likely to reduce an individual's loss of health-related quality of life as well as the personal and societal economic burdens.

Figure 1

The glaucoma continuum. Reprinted from Am J Ophthalmol; Vol 138; Weinreb RN, Friedman DS, Fechtner RD, et al.; “Risk assessment in the management of patients with ocular hypertension”; pages 458-467. Copyright 2004, with permission from Elsevier. CCT = central corneal thickness; C/D = cup/disc ratio; IOP = intraocular pressure; VF = visual field.

Figure 2

The prevalence of glaucoma is expected to rise between 2010 and 2020.

Figure 3

The majority of those with glaucoma are undiagnosed.^-

Figure 4

The financial burden of glaucoma increases with disease severity. Total annual direct cost of glaucoma treatment per patient by stage. Reprinted from Arch Ophthalmol; Vol 124; Lee PP, Walt JG, Doyle JJ, et al.; “A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma”; pages 12-19. Copyright © 2006 American Medical Association. All rights reserved.

Figure 5

Visual field loss negatively impacts health-related quality of life. Comparison of effect sizes (ES)s between the no visual field loss (VFL) subgroup with subgroups with different severity levels of VFL. The level of VFL was stratified into five categories: no VFL (mean deviation [MD] > _2 decibels [dB] in both eyes), unilateral mild VFL (-6 dB _2 dB in the other eye), bilateral mild VFL (_6 dB < MD < _2 dB in both eyes; or _6 dB < MD < _2 dB in one eye, MD < _6 dB in the other eye), and bilateral moderate to severe VFL (MD < _6 dB in both eyes). The ES was calculated as the difference in the adjusted mean scores (between each of the severity level of VFL and no VFL) divided by the standard deviation for the no VFL group. Subscales are clustered in decreasing order of ESs for the bilateral moderate to severe VFL vs none groups, for the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) vision-related subscales, and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) general health subscale scores. ESs below 0.20 represent no statistically significant effect. An ES of 0.20 to 0.49 is considered to be a small effect, 0.50 to 0.79 a medium effect, and 0.80 or more a large effect. Reprinted from Am J Ophthalmol; Vol 143; McKean-Cowdin R, Varma R, Wu J, et al.; “Severity of visual field loss and health-related quality of life”; pages1013-1023. Copyright 2007, with permission from Elsevier.

Figure 6

Visual field loss and health-related quality of life are positively associated. A. Better-seeing eye: Locally weighted least squares plot of the relationship of predicted 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) composite scores and the driving subscale score (adjusted for covariates) by visual field loss in the better-seeing eyes of participants with open-angle glaucoma in the Los Angeles Latino Eye Study. dB = decibels. B. Both eyes: Locally weighted least squares plot of the relationship of predicted 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) composite scores (adjusted for covariates) and calculated binocular visual field loss (VFL) (probability summation of data from the two eyes was used to compute a single binocular VFL score) of participants with open-angle glaucoma in the Los Angeles Latino Eye Study. Reprinted from Ophthalmology; Vol 115; McKean-Cowdin R, Wang Y, et al. “Impact of visual field loss on health-related quality of life in glaucoma: the Los Angeles Latino Eye Study”; pages 941-948. Copyright 2008, with permission from Elsevier.

Figure 7

Glaucoma patients face physical challenges. Proportion of subjects in the glaucoma group (n= 48) and the normal control group (n=47) who reported one or more falls in the previous 12 months. Proportion of drivers in the glaucoma group (n= 40) and the normal control group (n= 44) who reported one or more motor vehicle collisions (MVCs) in the previous 5 years. Data shown for self-reported MVCs (left) and police-reported MVCs (right), for all involvement (regardless of fault), and at-fault involvement. Province-recorded police reports were obtained for 38 and 44 drivers in the glaucoma and control groups, respectively. Police-reported at-fault MVCs were indeterminate for three of eight glaucoma and three of four control subjects with province recorded involvement. Reprinted with permission from Invest Ophthalmol Vis Sci; Vol 48; Haymes SA, Leblanc RP, Nicolela MT, et al. “Risk of falls and motor vehicle collisions in glaucoma”; pages 1149-1155. Copyright 2007.