• Written By:
    Comprehensive Ophthalmology, Glaucoma

    This retrospective study sought to better understand the real-world utility of laser trabeculoplasty in clinical practice through an examination of medical and pharmacy claims data.

    Predictably, the authors found that laser-treated patients had higher medical costs and lower pharmacy costs compared with medically managed patients, initially. However, the cost between the 2 groups was comparable at 2 years. The authors conclude that laser does not provide cost savings and may not be advantageous in resolving poor medication adherence.

    But I disagree. I think the interpretation of the data is flawed.

    Patients were allocated to 2 study cohorts: prostaglandin analogue (PGA) monotherapy plus laser (4,743 patients) or PGA monotherapy plus the addition/switch to alternative glaucoma medication class (16,484 patients).

    The authors emphasize that a majority of the laser group (80%) was back on at least 1 drop at 2 years. However, a similar rate of patients in the medical group were on 2 or 3 medications at 2 years (88%), thus laser does reduce the medical drop burden on the patients. Furthermore, the data showed a steady number of patients on 0 to 1 drop in the laser group between years 1 to 2, suggesting that the disease was under control with fewer drops compared with the medical group over the same time period. A reduction in the overall drop burden in laser patients would undoubtedly be of benefit in a non-compliant, non-responsive patient population.

    Another drawback of this study is that a claims database does not account for disease severity, clinical scenario, patient preference, disease progression or ocular comorbidities. Also of note is that Allergan is listed as a collaborator for the article, and provides funding to 3 of the 4 authors of the study, so I’m wary of an interpretation of the data that seems to downplay the importance of laser trabeculoplasty in-lieu of medications in clinical practice. In fact, the authors write in the abstract that laser was associated with “greater overall costs,” even though the 2-year costs only differed by $33 and was not significantly different.

    The decision to offer patients laser surgery or additional medications to control their glaucoma is multi-dimensional and should be made on an individual basis. This article does illustrate that laser patients are on fewer drops at 2 years compared with medical managed patients and with comparable costs, and suggests that laser would be especially beneficial in those who are noncompliant, drop intolerant or have poor or no prescription insurance.