OBJECTIVES: One of the main objectives of glaucoma treatment is to lower intraocular pressure through topical medication, laser, or more invasive procedures (surgery, or surgical implants). In addition, long-lasting drug depots may also soon be a treatment option. The aim of current review was to identify the patient preferences towards glaucoma treatment and relevant influencing factors.

METHODS: A comprehensive literature search was performed for studies published in English from inception through August 2017 in Embase, MEDLINE, MEDLINE-In Process, and Cochrane library. Studies reporting patient preferences for any glaucoma treatment were included.

RESULTS: The review identified 32 studies (7 RCTs, 1 non-RCTs, 12 observational studies and 7 single-arm studies) including studies assessing treatment-switching (n=11) and factors influencing treatment preference (n=5). Patients receiving monotherapies had significantly higher treatment satisfaction compared to polytherapies (p=0.05). Topical agents (QD regimen) were more convenient compared to BID regimens (p=0.104). Among monotherapies, brimonidine was preferred over topical β-blockers (less efficacious) or dual therapies (less convenient); travoprost BAK-free over latanoprost; and bimatoprost over travoprost. Patients switching from PGA monotherapies or mono/adjunctive therapies were significantly more likely to accept fixed-dose combinations such as travoprost/timolol. Additionally, studies reported high patient willingness to accept a novel glaucoma treatment such as sustained drug delivery (via punctal plug, subconjunctival or intracameral route) and implant (p=0.011) based upon effectiveness and cost. Other factors influencing patient preference were clear center vision, outdoor mobility, travelling distance during follow-ups, and treatment-associated symptoms (vision blurring, drowsiness, or inhibition of sexual performance). No studies assessing surgical treatment options were identified.

CONCLUSIONS: Evidence clearly indicates that glaucoma patients have preference towards more efficacious and less frequent medication regimens. In addition, patients are willing to accept novel treatment options such as surgical implants and sustained release medication depots. However, scarce evidence necessitates the need for more research focusing on patient preferences towards surgical treatment options.