Prioritizing Outcome Preferences in Patients with Ocular Hypertension and Open-Angle Glaucoma Using Best–Worst Scaling

Purpose: To quantify patients’ preferences for glaucoma outcomes and use this information to prioritize outcomes that are important to patients. Design: Cross-sectional study using best–worst scaling (BWS) object case. Participants: Two hundred seventy-four participants newly diagnosed with ocular hypertension or mild to moderate open-angle glaucoma from 3 private practices and 1 academic medical center in the United States. Methods: We designed a preference-elicitation survey based on findings from qualitative interviews with patients with glaucoma (reported separately). The survey asked participants to rate the importance of 13 glaucoma outcomes on a 5-point scale as a warm-up exercise followed by completion of 13 BWS tasks. For each task, we presented participants with a subset of 4 outcomes from the possible 13, and participants chose the most important and least important outcome. Outcomes included in the survey pertain to maintaining ability to perform vision-dependent activities of daily living (e.g., driving), maintaining visual function and perception, minimizing need to take glaucoma drops, not experiencing ocular surface symptoms, and having adequate control of intraocular pressure (IOP). We administered the survey online and analyzed response patterns using conditional logistic regression to determine the relative importance of outcomes. Main Outcome Measure: Ordinal ranking of glaucoma outcomes based on preference weights. Results: Between September 1, 2017, and February 28, 2018, we invited 1035 patients to complete the survey, of whom 274 (26%) responded. Most participants were older than 65 years (146/274 [53%]) and at the time were taking IOP-lowering drops (179/274 [65%]). Participants identified that outcomes with the largest relative importance weight were having “adequate IOP control” and ability to “drive a car during the day,” and outcomes with the smallest relative importance weights were “maintaining appearance of the eye” and “reducing the number of IOP-lowering drops.” Conclusions: Determining the relative importance of glaucoma outcomes to patients can help researchers to design studies that may inform clinical and regulatory decision-making better. Although IOP is an outcome that researchers often measure in glaucoma clinical trials, we found that patients also prioritized outcomes related to the ability to perform vision-dependent activities (e.g., driving) as important.