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Effective Health Care Program

Topic Suggestion Description

Date submitted: November 23, 2008

1. Your Nomination - Please briefly describe in your own words the question about a health care test or treatment that interests or concerns you:

My nomination is about comparing outcomes of different glaucoma treatments, particularly canaloplasty to trabeculectomy and to medical therapy alone.

2. Why do you think your question is important? (you may select more than one category if appropriate)
 My question relates to a very common disease or problem

 People with this disease or problem have considerable health or financial hardships

 There is uncertainty about how well the test, treatment, or intervention works

 There is significant potential for side effects/harms using this test, treatment, or intervention

 Funding of this test, treatment, or intervention is uncertain or variable

 There is unequal access or application of this health care intervention across providers

 There is potential for cost savings from better information on this subject

 This is a new technology/development

 There is new evidence of clinical and/or cost effectiveness for this test, treatment, or intervention


3. What illness or health condition is related to your question? (You can also specify a particular health-promoting activity, such as breast-feeding)
4. What group(s) or patients does your question apply to?
Glaucoma affects one in two hundred people aged fifty and younger, and one in ten over the age of eighty. Glaucoma often occurs with age, and African-Americans are at higher risk.
5. What is the specific purpose of the health care test or treatment you have a question about? (mark all that you think apply)
Identification of a disease or condition:

 Screening or diagnosis/identification for a particular disease, or risk assessment for a disease

 Risks or harms that can come from a disease identification tool or test

 Diagnostic tests and tools

 Diagnosis of co-occurring diseases

 Intervention (such as a drug treatment, therapy, device)

 Management of a condition or particular system of care

 Delivery of a health service


 Risks or harms associated with treatment of a disease or condition

 Prevention or health promotion

 Specific population health concerns, such as ethnic group or gender


 Dont know

6. Does your question include a comparison of different health care approaches?

If yes, please list what you would like to see compared:
7. Desired Health Improvements: If you question focuses on:
Identification of a particular disease or condition, what improvements in identification or diagnosis would you like to see?

Treatment of a particular disease or condition, what improvements in patient symptoms or problems would you like to see?
Reductions in interocular eye pressure and blindness.
8. Harms: Are there risks, side effects, or harms you are concerned about? If yes, please specify what those are:
Canaloplasty is a new, minimally invasive surgery for glaucoma and it is considered as effective as traditional surgery but presumably with fewer complications. The evidence base is growing and short-term data data on canaloplasty look as if it is fairly safe and effective, but some long-term outcomes are not well studied.
9. Based on your answers to the previous questions, what research question(s) would you like to have answered?
What are the health risks and benefits of trabeculectomy as compared to alternatives, including laser surgery, trabectome, and canaloplasty. What types of individuals continue to require ocular or glaucoma medications after surgery. Does treatment response vary for African-Americans as compared to those who are not African Americans? Does age modify this risk?
10. Are there health-care focused, disease-focused, or patient-focused organizations that you see as being relevant to this issue? Who do you think we should contact as we consider your nomination?
American Glaucoma Society
11. Other Information About You (OPTIONAL)
In order to help us understand the context of your health care question, it would be helpful to know more about you. The answers you give will not influence the progress of your suggestion. Thank you.
a. Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Patient/consumer (individual)

b. Is there any other information about you that is relevant to your question?

I am the adult child with a parent and a grandparent with glaucoma

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


Treatment for Glaucoma: Comparative Effectiveness