Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For newly diagnosed patients with open-angle glaucoma, what is the comparative effectiveness of medication versus laser surgery in controlling 24-hour intraocular pressure?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Drug versus laser surgery as the primary treatment.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Newly diagnosed patients with open-angle glaucoma who need to be treated by lowering intraocular pressure.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

To find out which primary treatment, drug or laser surgery, is more effective in maintaining 24-hour efficacy.

Describe any health-related risks, side effects, or harms that you are concerned about.

Long-term use of eyedrops and laser surgery carry different sets of risks and side effects to the patients.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Functional limitations and disability

AHRQ Priority Populations

• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

For the treatment of open-angle glaucoma, it is desirable to have a lowering of intraocular pressure throughout day and at night. It is not clear whether or not laser surgery as the primary treatment can lower intraocular pressure at night and how well when compared to the use of medications.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The preferred practice pattern in treating open-angle glaucoma in the United Sates is to start with a medication. It may cost more and have more side effects after long-term use, compared to laser surgery. However, the effectiveness of laser surgery as a primary treatment at night is unclear.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is no data available in the literature regarding whether laser surgery alone is more effective in lowering intraocular pressure at night.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

An answer to this question will help physicians and patients make an informed choice.

Describe the timeframe in which an answer to your question is needed.

Glaucoma progression is usually slow. Patients may be under a primary treatment for several years. An answer to the proposed question should have an immediate impact.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

When patients with open-angle glaucoma are unable to apply eyedrops on a daily basis, such as having dementia, laser surgery is considered an alternative.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

An answer to this question will help physicians and patients make an informed choice.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program