New assessment tool could make patient-reported outcomes part of routine glaucoma practice

Patient-reported outcomes measures (PROMs), in their current form, will probably have a limited role in routine glaucoma practice due to lack of comprehensiveness, despite a desire and willingness to comply with them among patients who use them. These are the conclusions of the authors of this prospective study. However, they used their data to devise a new instrument that could fill in the gaps, and may be helpful for identifying patients at risk for nonadherence to treatment and in guiding clinicians in their management.

The authors analyzed 42 comments on the use of PROMs and PREMS (patient-reported experience measures) for glaucoma that were solicited in focus group discussions led by staff workers in the field of ophthalmology.

They found that participants were prepared to support the use of PROMs if the instrument was short, practical and useful. However, they identified several potential barriers to the use of PROMs in routine practice, including bureaucratic overload and accessibility issues.

Furthermore, while current instruments appear to cover many of the domains identified by the participants as important, no instrument covered all of the domains, and it is unclear if any existing instrument has practical value in routine practice.

Group discussion informed by the literature and research findings led to the formulation of the following six-item instrument, which the authors call a "glaucoma patient-reported outcome and experience measure" (POEM):

• Are you frightened of going blind from glaucoma?
• On balance, is your glaucoma treatment (and any side effects) acceptable to you?
• Does your glaucoma interfere with your daily life?
• Do you feel safe under the care of your glaucoma team?
• Do you think your glaucoma is getting worse?
• Do you understand your diagnosis and treatment plan?

Although the POEM instrument the authors have proposed has not yet been validated in clinical practice, it represents a simple, elegant initial attempt at a glaucoma-specific instrument that may be useful in patients' self-assessment of their glaucoma status.