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E W GLAUCOMA 130 by Erin L. Boyle EyeWorld Senior Staff Writer Burden of care cost high in glaucoma Glaucoma is costly not only in monetary terms but also in terms of patients' quality of life W hile many glaucoma patients live normal lives, some glaucoma patients cannot drive, or administer their eye drops. Some cannot find jobs. The high cost of the burden of glaucoma blindness can be meas- ured not only in the direct monetary cost to the healthcare system and society, but also in the diminished quality of life in patients impacted by the disease. "The take-home message is pro- viding eyecare is very expensive," said Augusto Azuara-Blanco, MD, PhD, Queen's University, Belfast, U.K. "It's also very difficult to live a normal life if patients don't have good vision, and this often leads to anger, depression, and isolation," he said. Continued research is needed to find the best and least expensive treatment options for glaucoma pa- tients, to halt progression and save vision, he said. However, funding that research is difficult because glaucoma is up against many other important healthcare needs, so glau- coma advocates and physicians must do all they can to accurately meas- ure and portray the true burden of glaucoma to policy makers. "We are competing among dif- ferent areas of health, and this is an important concept that if we invest in a particular area—for example, an emergent treatment for cancer— then we don't have the opportunity to use resources in other areas, and this is the cost of opportunity," Prof. Azuara-Blanco said. "We as a society have to be very careful where we put our money." Direct cost The statistics are well known within the ophthalmic community: Glau- coma is the second leading cause of blindness in the world. The preva- lence and incidence of glaucoma increases with age. The aging popu- lation is growing at a rapid rate. These are the facts, Prof. Azuara- Blanco said. Physicians need to emphasize both the facts and the incredible quality of life impact that the burden of severe glaucoma has on patients, their families, their friends, and society as a whole. "Vision is so precious," he said. "We now have good evidence to tell decision makers that vision is very important for the quality of life. We have evidence about how much it affects the quality of life. The impor- tant aspect is that most interven- tions are going to make a difference, and the clinical outcomes are going to be cost effective." In the U.K., where Prof. Azuara- Blanco practices, more than £500 million a year is spent in medical care (direct cost) for glaucoma pa- tients. In the U.S., that cost is nearly $3 billion. Research has shown that the top two most expensive aspects of care are eye drops and office vis- its. Indirect cost Indirect costs are even more expen- sive, he said. The U.K.'s National In- stitutes of Health estimates that the indirect costs are about £4.3 billion there—more than twice as much spent on eyecare (direct costs) per year in the U.K. The indirect cost of the burden of blindness impacts family and friends as well as glaucoma patients, Prof. Azuara-Blanco said. " The most significant compo- nents of the societal cost would be related to family and friends in the form of care," he said. "For example, [family or friends will assist in] putting drops in for the patient, taking the patient to appointments, or reading the mail." When vision worsens, patients a re often physically impacted. They have issues with walking into objects and not being able to read or drive. They also experience an increase in falls and hip fractures, he said. A testimonial from a glaucoma patient describes the experience of seeing a second doctor to confirm a g laucoma diagnosis and switching to another treatment option to reduce side effects. The patient's concern is clear, Prof. Azuara-Blanco said. "I have lost peripheral vision in both eyes, more in one than the other, but I still have good central vision. I worry a lot about what is to come, even though there is nothing I can do about it," the patient stated. This patient's cost of burden of disease can be quantified by the use of standardized validated question- naires, Prof. Azuara-Blanco said. "People who have severe visual impairment rank their quality of life very poorly, 57% compared to full health of 100%. That's a very poor standard of life," he said. He is interested in how physi- cians perceive their glaucoma pa- tients' loss of vision. If patients are asked how they rate their quality of life with visual loss, they often rank it as low. "But when we ask doctors or members of the public, we tend to underestimate how bad they are," he said. "We can translate this impair- ment of quality of life in disability and economic terms," he said. Prof. Azuara-Blanco presented the information at the 2013 Euro- pean Glaucoma Society/European Society of Cataract & Refractive Surgeons' Glaucoma Day. EW EditorsÕ note: Prof. Azuara-Blanco has no financial interests related to this article. Contact information Azuara-Blanco: a.azuara-blanco@qub.ac.uk February 2011 March 2014 130-135 Glaucoma_EW March 2014-DL2_Layout 1 3/6/14 4:12 PM Page 130