Feasibility and Acceptability of a New Clinical Pathway for the Identification of Non-responders to Glaucoma Eye Drops: The TRIAGE Study

Dr Simon Read

Organisation/institution: Swansea Centre of Health Economics (SCHE) at Swansea University, Cardiff University, Research Design and Conduct Service (RDCS)

Key contact: Dr Simon Read, SCHE, Swansea University, s.m.read@swansea.ac.uk

What was the question that we could help with?

The research explored changing pathways for clinical care for people with glaucoma. Patients with glaucoma can develop higher-than-expected intraocular pressure (IOP) despite being prescribed ocular hypotensive eye-drops. This can be problematic for clinicians given that IOP is a product of both the physiological response and patient adherence.

What did we do?

In collaboration with the RDCS, we supported a successful grant to the Health and Care Research Wales Research for Patient and Public Benefit (RfPPB) scheme. The study assessed whether the Cardiff Model of Glaucoma Care (CMGC), a clinical pathway aimed to unpick these issues, was acceptable to patients and health care professionals, and provided novel information on non-responsiveness and non-adherence to latanoprost ocular hypotensive treatment. We evaluated the resource impact and costs of the CMCG pathway relative to usual care and found solutions to challenges in the recruitment and delivery of the research. Health and Care Economics Cymru health economists worked closely with the qualitative research team and contributed to development of themes and recommendations together with delivering the health economics components. Such contributions are crucial to change the common perception that health economists ‘just do the costing at the end’.

Jigsaw Pieces

What was the impact?

The fruitful cooperation with Dr Simon Read, the sociologist on the study team, resulted in a further collaboration on another research project and we learned more about each other’s disciplines to mutual benefit. Simon has now joined SCHE and Health and Care Economics Cymru as a researcher, to harness this synergy to support other studies. The health economics contribution was critical in identifying that the new pathway would incur minimal financial or resource impact if the pathway was changed. Other barriers to change were identified but removing financial worries is essential for gaining the attention of service managers. The study provided robust evidence to inform glaucoma pathway development with improved clinical benefit as part of delivering quality care to improve the health for individuals and families in Wales.

The TRIAGE study was an invaluable experience, offering new findings on health care pathways, medication non-responsiveness and adherence, implementation of complex interventions, and patient experience. We published two articles with a third under review and opened up new dialogues on the management of chronic eye conditions such as glaucoma. I’m delighted that my work on the study led to my transition into WHESS [now Health and Care Economics Cymru], collaborations on new research studies and my professional development” Dr Simon Read.


Waterman, H., Read, S., Morgan, J. E., Gillespie, D., Nollett, C., Allen, D., Weiss, M., & Anderson, P. (2020). Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study. British Journal of Ophthalmology.

Read, S., Morgan, J., Gillespie, D., Nollett, C., Weiss, M., Allen, D., Anderson, P., & Waterman, H. (2020). Chronic Conditions and Behavioural Change Approaches to Medication Adherence: Rethinking Clinical Guidance and Recommendations. Patient Preference and Adherence, 14, 581.