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Open-angle Glaucoma

Ophthalmology
79
Pipeline Programs
16
Companies
50
Clinical Trials
1 recruiting
3
Approved Products

Pipeline by Development Stage

Preclinical
Phase 1
Phase 1/2
Phase 2
Phase 2/3
Phase 3
On Market
0
1
1
15
0
36
26
Early DiscoveryClinical DevelopmentMarket

Drug Modality Breakdown

Small Molecule
1100%
+ 97 programs with unclassified modality

Ophthalmology is a $3.7B market with a mature, consolidating portfolio dominated by glaucoma treatments and emerging corneal/retinal therapies.

$3.7B marketMature→ Stable30 products15 companies

Key Trends

  • Glaucoma therapeutics (prostaglandin analogs, adrenergic agents) represent 60%+ of spending but face patent cliffs 2028-2034
  • Innovative mechanisms (NGF agonists, LFA-1 antagonists, RTKIs) gaining traction in dry eye and retinal disease segments
  • Heavy trial activity (2,656 total) skewed toward Phase 4 (369) and Phase 3 (442), indicating mature clinical development landscape

Career Verdict

Ophthalmology offers stable mid-career opportunities with strong Commercial and Medical Affairs salaries, but limited innovation catalysts and significant patent cliff risk warrant careful timing of entry.

AI-generated market analysis based on FDA, CMS, ClinicalTrials.gov, and hiring data

Market Leaders

#1LUMIGANDeclining
$697M
AbbVie·LOE_APPROACHING
#2OXERVATEStable
$493M
Unspecified·PEAK
#3XIIDRAStable
$473M
Bausch + Lomb·PEAK7.6yr
#4INLYTAGrowing
$467M
Pfizer·PEAK11.2yr
#5HUMIRADeclining
$258M
AbbVie·LOE_APPROACHING

Drug Class Breakdown

Prostaglandin Analogs (Bimatoprost)
$697M(19%)

mature, losing exclusivity

Nerve Growth Factor Agonists
$493M(13%)

peak growth in corneal disease

LFA-1 Antagonists (Dry Eye)
$473M(13%)

sustained peak sales

Receptor Tyrosine Kinase Inhibitors
$467M(13%)

expanding in retinal indications

Alpha-2 Adrenergic Agonists
$362M(10%)

mature, multiple LOE approaching

Combination Therapies (Brimonidine/Timolol)
$232M(6%)

mature, losing exclusivity

Complement Inhibitors
$223M(6%)

mature immunology approach

Career Outlook

Stable

Ophthalmology offers predictable mid-career growth with strong Commercial ($158K) and Medical Affairs ($247K) compensation but faces structural headwinds: patent cliffs 2028-2034 eliminate $97M in revenue, glaucoma franchise maturity limits blockbuster potential, and modest trial volume (2,656) signals incremental R&D expansion. Best suited for professionals seeking stable roles in established therapeutic areas rather than disruptive innovation.

Breaking In

Enter via Clinical Operations or Commercial analyst roles at CROs (Syneos 210 jobs) or large diagnostics players (Labcorp 904) to build domain expertise before targeting pharma MSL/Medical Affairs positions.

For Experienced Professionals

Experienced professionals should prioritize Medical Affairs and Market Access roles leveraging mature market knowledge; avoid product-specific expertise in glaucoma due to patent cliff concentration, and consider adjacent areas (retinal, corneal) where innovation catalysts remain.

In-Demand Skills

Glaucoma/dry eye clinical expertise and key opinion leader relationshipsRegulatory navigation for mature small-molecule formulations and device combinationsMarket access and reimbursement strategy (high generic/biosimilar pressure)

Best For

Medical Science Liaison (MSL) — strong $247K average salary, KOL interface criticalCommercial/Brand Manager — competitive $158K salaries, established product lifecycle managementClinical Operations Manager — high hiring volume (409 jobs), trial coordination in Phase 4-heavy pipeline

Hiring Landscape

$59K-$247K

Ophthalmology hiring (3,202 jobs) is distributed across diagnostics/devices (Labcorp 904, Abbott 348) and pharma commercial functions rather than concentrated in R&D. Top pharmaceutical employers (Pfizer 60, AstraZeneca 100, Regeneron 168) show modest pharma-specific headcount relative to market size, suggesting outsourced CRO and distributor dependency. Medical Affairs ($247K avg salary) commands premium compensation, signaling high barrier to entry but strong mid-career upside.

3,202
Open Roles
5
Companies Hiring
5
Departments

Top Hiring Companies

Labcorp
904Growing
Abbott
348Stable
MicroAire Surgical Instruments
245Stable
Regeneron
168Growing
Danaher
219Stable

By Department

Clinical Operations(13%)
$150K
Commercial(10%)
$158K
Medical Affairs(3%)
$247K
R&D(6%)
$145K
Engineering(9%)
$112K

Clinical Operations and Commercial roles offer entry-level stability ($150K-$158K); Medical Affairs commands premium salaries ($247K) but requires advanced credentials; limited R&D hiring (207 jobs) suggests constrained innovation investment.

On Market (3)

Approved therapies currently available

AbbVie
LUMIGANApproved
bimatoprost
AbbVie
ophthalmic2001
697M Part D
AbbVie
DURYSTAApproved
bimatoprost
AbbVie
Prostaglandin Analog [EPC]ophthalmic2020
965K Part D
AbbVie
LATISSEApproved
bimatoprost
AbbVie
Prostaglandin Analog [EPC]topical2008

Competitive Landscape

15 companies ranked by most advanced pipeline stage

Alcon
AlconFORT WORTH, TX
60 programs
15
26
17
Brinzolamide 1%/Brimonidine 0.2% ophthalmic suspensionPhase 41 trial
Brinzolamide 1%/Timolol maleate 0.5% fixed combination ophthalmic suspensionPhase 4
Brinzolamide 1%/brimonidine 0.2% tartrate ophthalmic suspensionPhase 41 trial
Brinzolamide 1%/brimonidine tartrate 0.2% ophthalmic suspensionPhase 41 trial
Brinzolamide 1.0% + Timolol 0.5% ophthalmic suspensionPhase 41 trial
+55 more programs
Active Trials
NCT01485822Terminated88Est. Feb 2012
NCT00047554Terminated336Est. Jun 2012
NCT00069706Completed118Est. Oct 2003
+56 more trials
AbbVie
AbbVieNORTH CHICAGO, IL
10 programs
1
3
5
XEN45 Glaucoma Treatment SystemPhase 41 trial
LATISSE(bimatoprost)Phase 45 trials
brimonidine 0.1%Phase 41 trial
brimonidine tartrate 0.2%/timolol maleate 0.5% fixed combinationPhase 41 trial
brimonidine tartrate 0.2%/timolol maleate 0.5% fixed combinationPhase 41 trial
+5 more programs
Active Trials
NCT01781962Terminated206Est. Jun 2013
NCT04499248Recruiting96Est. Feb 2029
NCT05411198Completed74Est. Feb 2026
+11 more trials
Sandoz
SandozAustria - Kundl
1 program
1
Brinzolamide 1%/Timolol maleate 0.5% fixed combination ophthalmic suspensionPhase 4
Bausch Health
Bausch HealthQUEBEC, Quebec, Canada
2 programs
2
BOL-303259-XPhase 31 trial
BOL-303259-XPhase 31 trial
Active Trials
NCT01749904Completed420Est. Sep 2015
NCT01749930Completed420Est. May 2015
Bausch + Lomb
Bausch + LombNJ - Bridgewater
2 programs
2
BOL-303259-XPhase 3
BOL-303259-XPhase 3
Sharp Therapeutics
Sharp TherapeuticsPA - Pittsburgh
1 program
1
Preservative-Free TafluprostPhase 3
MSD
MSDIreland - Ballydine
1 program
1
Preservative-Free TafluprostPhase 31 trial
Active Trials
NCT01026831Completed643Est. Sep 2010
Pfizer
PfizerNEW YORK, NY
1 program
1
latanoprostPhase 35 trials
Active Trials
NCT01180062Terminated12Est. Jun 2014
NCT01191008Completed661Est. May 2015
NCT00934089Completed31Est. Jun 2010
+2 more trials
PolyActiva
PolyActivaAustralia - Notting Hill
1 program
1
PA5108Phase 11 trial
Active Trials
NCT03604328Completed8Est. Jun 2020
Glaukos
GlaukosALISO VIEJO, CA
8 programs
One iStentN/A1 trial
iStentN/A1 trial
iStent and iStent supraN/A1 trial
Implantation of two iStent inject micro-bypass stentsPHASE_41 trial
StentPHASE_41 trial
+3 more programs
Active Trials
NCT01455467Completed79Est. Oct 2019
NCT01444105Completed80Est. Apr 2019
NCT01456390Completed79Est. Mar 2019
+5 more trials
Santen
SantenCA - Emeryville
7 programs
DE-104 medium concentrationPHASE_1_21 trial
DE-112PHASE_1_21 trial
DE-104 ophthalmic solutionPHASE_21 trial
DE-104 ophthalmic solution, low concentrationPHASE_21 trial
DE-104 ophthalmic solution, low concentrationPHASE_21 trial
+2 more programs
Active Trials
NCT00868894Completed49Est. Jun 2010
NCT01279083Completed147Est. Feb 2012
NCT00656240Completed
+4 more trials
Iantrek
IantrekNY - White Plains
1 program
AlloSpan Canal Platform Bio-Reinforced CanaloplastyN/A1 trial
Active Trials
NCT07520175Enrolling By Invitation300Est. Dec 2029
Biomed
BiomedAustralia - Sydney
1 program
Trabecular Meshwork Microstent Drainage SystemN/A1 trial
Active Trials
NCT06741774Active Not Recruiting207Est. May 2026
Merck & Co.
Merck & Co.RAHWAY, NJ
1 program
Preservative-Free TafluprostPHASE_3
Novartis
NovartisBASEL, Switzerland
1 program
Brinzolamide 1%/Timolol maleate 0.5% fixed combination ophthalmic suspensionPHASE_41 trial
Active Trials
NCT02325518Completed218Est. Dec 2015

Trial Timeline

Clinical trial activity over time

2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
AbbViebimatoprost
AbbVieXEN45 Glaucoma Treatment System
AbbViebimatoprost
AlconBrinzolamide 1%/brimonidine tartrate 0.2% ophthalmic suspension
AbbViebimatoprost
AbbViebimatoprost
AlconBrinzolamide 1%/brimonidine 0.2% tartrate ophthalmic suspension
NovartisBrinzolamide 1%/Timolol maleate 0.5% fixed combination ophthalmic suspension
AbbViebimatoprost
AbbViebimatoprost
AlconBrinzolamide 1%/Brimonidine 0.2% ophthalmic suspension
AbbViebimatoprost
AbbViebimatoprost
GlaukosImplantation of two iStent inject micro-bypass stents
AbbViebimatoprost

Showing 15 of 50 trials with date data

Clinical Trials (50)

Total enrollment: 9,089 patients across 50 trials

NCT07217678AbbViebimatoprost

Biomarkers of Ocular Surface Damage in the Setting of Topical Ocular Hypotensive Medication Use

Start: Feb 2026Est. completion: Jan 202820 patients
Phase 4Recruiting
NCT05821855AbbVieXEN45 Glaucoma Treatment System

A Study to Evaluate Adverse Events and Change in Disease Activity With the XEN45 Glaucoma Treatment System Implantation In Adult Participants With Open-Angle Glaucoma in China

Start: Jan 2024Est. completion: Jul 2030120 patients
Phase 4Active Not Recruiting
NCT02863705AbbViebimatoprost

Efficacy and Safety of COMBIGAN® in Korean Patients With Primary Open Angle Glaucoma (POAG) and Normal Tension Glaucoma (NTG)

Start: Jul 2016Est. completion: Jul 2018118 patients
Phase 4Completed
NCT02730871AlconBrinzolamide 1%/brimonidine tartrate 0.2% ophthalmic suspension

Safety and Efficacy of SIMBRINZA® BID as an Adjunctive to DUOTRAV®

Start: Jun 2016Est. completion: Jul 2018173 patients
Phase 4Terminated
NCT02571712AbbViebimatoprost

Safety of GANFORT® Ophthalmic Solution in Chinese Patients With Open-angle Glaucoma or Ocular Hypertension

Start: Nov 2015Est. completion: Jun 2018750 patients
Phase 4Completed
NCT02471105AbbViebimatoprost

Investigation of IOP and Tolerability of Bimatoprost 0.01% and Tafluprost Unit Dose Preservative Free 15 Microgram/ml

Start: Sep 2015Est. completion: Dec 201767 patients
Phase 4Unknown
NCT02419508AlconBrinzolamide 1%/brimonidine 0.2% tartrate ophthalmic suspension

SIMBRINZA® Suspension BID as an Adjunctive to Prostaglandin Analogue (PGA)

Start: Aug 2015Est. completion: Feb 2018290 patients
Phase 4Completed
NCT02325518NovartisBrinzolamide 1%/Timolol maleate 0.5% fixed combination ophthalmic suspension

Comparison of Intraocular Pressure (IOP)-Lowering Efficacy and Safety of AZORGA® Ophthalmic Suspension and COSOPT® Ophthalmic Solution

Start: Dec 2014Est. completion: Dec 2015218 patients
Phase 4Completed
NCT02176356AbbViebimatoprost

Patient Satisfaction Study of Combined Facial Treatment With BOTOX® Cosmetic, JUVÉDERM® and LATISSE® (HARMONY Study)

Start: Jun 2014Est. completion: May 2015116 patients
Phase 4Completed
NCT02097719AbbViebimatoprost

Efficacy and Safety Study of Bimatoprost 0.01% Alone Compared With Travoprost 0.004% and Timolol 0.5% in Subjects With Glaucoma or Ocular Hypertension

Start: May 2014Est. completion: Dec 2014100 patients
Phase 4Completed
NCT01978600AlconBrinzolamide 1%/Brimonidine 0.2% ophthalmic suspension

Evaluation of Intraocular Pressure Using Simbrinza™ in Patients With Open-Angle Glaucoma or Ocular Hypertension

Start: Oct 2013Est. completion: Mar 201489 patients
Phase 4Completed
NCT01881126AbbViebimatoprost

An Efficacy and Safety Study of Bimatoprost 0.01% Alone Compared With Travoprost 0.004% and Timolol 0.5% in Subjects With Glaucoma or Ocular Hypertension

Start: Jun 2013Est. completion: Oct 201493 patients
Phase 4Completed
NCT01891487AbbViebimatoprost

Safety and Efficacy of Bimatoprost 0.03% Solution for the Treatment of Thinning Eyebrows

Start: May 2013Est. completion: Jan 201533 patients
Phase 4Completed
NCT02873806GlaukosImplantation of two iStent inject micro-bypass stents

Two Trabecular Micro-bypass Stents & Postoperative Travoprost to Treat Glaucoma Subjects on Two Hypotensive Agents

Start: Mar 2013Est. completion: Nov 201953 patients
Phase 4Completed
NCT01594970AbbViebimatoprost

A Safety and Efficacy Study of Bimatoprost 0.01% in Primary Open-Angle Glaucoma (POAG) or Ocular Hypertension (OH)

Start: Mar 2012Est. completion: Jan 2013800 patients
Phase 4Completed
NCT01510145AlconTravoprost 0.004% BAK-free

Efficacy of Changing to TRAVATAN® From Prior Therapy

Start: Feb 2012Est. completion: May 2013191 patients
Phase 4Completed
NCT01510132AlconTravoprost/timolol fixed combination

Travacom Post Marketing Surveillance Study

Start: Jan 2012Est. completion: Jan 20120
Phase 4Withdrawn
NCT01525173AbbViebimatoprost

A Safety and Efficacy Study of ALPHAGAN® P and LUMIGAN® in Subjects Previously Treated With Latanoprost for Glaucoma and Ocular Hypertension

Start: Jan 2012Est. completion: Oct 2012137 patients
Phase 4Completed
NCT01547598AbbViebimatoprost

Safety and Efficacy of LUMIGAN® RC Versus DuoTrav® in Patients Who Require Further Intraocular Pressure (IOP) Reduction

Start: Dec 2011Est. completion: Jul 2013135 patients
Phase 4Completed
NCT01493427AlconTravoprost 0.004%

Efficacy of Changing to TRAVATAN® From Prior Therapy

Start: Dec 2011Est. completion: Feb 2013202 patients
Phase 4Completed
NCT01448525AbbViebimatoprost

Study Assessing Patient Satisfaction With LATISSE® for Increasing Eyelash Prominence

Start: Oct 2011Est. completion: Apr 201288 patients
Phase 4Completed
NCT01443988GlaukosiStent

Subjects With Open-angle Glaucoma, Pseudoexfoliative Glaucoma, or Ocular Hypertension Naïve to Medical and Surgical Therapy, Treated With Two Trabecular Micro-bypass Stents (iStent)or Travoprost

Start: Sep 2011Est. completion: Apr 2017101 patients
Phase 4Completed
NCT01444040GlaukosiStent inject

Subjects With Open-angle Glaucoma, Pseudoexfoliative Glaucoma, or Ocular Hypertension Naïve to Medical and Surgical Therapy, Treated With Two Trabecular Micro-bypass Stents (iStent Inject) or Travoprost

Start: Sep 2011Est. completion: Mar 2019196 patients
Phase 4Completed
NCT01340014AlconBrinzolamide 1.0% + Timolol 0.5% ophthalmic suspension

Patient Preference Comparison of AZARGA Versus COSOPT

Start: Sep 2011Est. completion: Oct 2012112 patients
Phase 4Completed
NCT01327599AlconTravoprost 0.004%+Timolol 0.5% ophthalmic solution

Efficacy of Changing to DUOTRAV® From Prior Therapy

Start: Aug 2011Est. completion: Nov 201260 patients
Phase 4Completed
NCT02020512AbbViebimatoprost

A Study of 0.03% Bimatoprost in the Treatment of Primary Open Angle Glaucoma and Ocular Hypertension

Start: Jul 2011Est. completion: Dec 201287 patients
Phase 4Completed
NCT01298700AbbViebimatoprost

Long-Term Safety of Bimatoprost Ophthalmic Solution in Patients With Glaucoma or Ocular Hypertension

Start: May 2011Est. completion: Dec 2016806 patients
Phase 4Completed
NCT01387906AbbViebimatoprost

Latisse (Bimatoprost .03% Opthalmic Solution) for the Treatment of Hypotrichosis of the Eyebrows: Latisse Versus Placebo

Start: Mar 2011Est. completion: Jun 201220 patients
Phase 4Completed
NCT01253902AbbViebimatoprost

Ocular Surface Tolerability Study of Prostaglandin Analogues in Patients With Open-Angle Glaucoma or Ocular Hypertension

Start: Dec 2010Est. completion: Oct 2011164 patients
Phase 4Completed
NCT01023841AbbViebimatoprost

Safety and Efficacy of Bimatoprost Solution in Treating Eyelash Loss or Hypotrichosis in Children

Start: Jun 2010Est. completion: Nov 201271 patients
Phase 4Completed
NCT01243567AbbViebimatoprost

Safety and Efficacy of Bimatoprost/Timolol Fixed Combination Versus Latanoprost in Patients With Open-Angle Glaucoma Who Have Never Been Treated

Start: Jun 2010Est. completion: Feb 201281 patients
Phase 4Completed
NCT02061683AbbViebimatoprost

A Study of Bimatoprost in the Treatment of Primary Open Angle Glaucoma and Ocular Hypertension

Start: Apr 2010Est. completion: Jun 2011263 patients
Phase 4Completed
NCT01833741AbbViebimatoprost

A Study of LUMIGAN® RC in the Clinical Setting

Start: Dec 2009Est. completion: Mar 20111,137 patients
Phase 4Completed
NCT01170884AbbViebimatoprost

Comparing Safety and Efficacy of Combigan® and Lumigan® With Lumigan® Alone in Glaucoma or Ocular Hypertension Subjects Treated With Xalatan®

Start: Dec 2009Est. completion: Sep 2010121 patients
Phase 4Completed
NCT01229423AbbViebimatoprost

Safety and Efficacy of LATISSE® in the Augmentation of Eyelashes of Korean Subjects

Start: Nov 2009Est. completion: Oct 201062 patients
Phase 4Completed
NCT00958035AbbViebimatoprost

Study of Bimatoprost Solution in Increasing Eyelash Prominence in African Americans With Eyelash Hypotrichosis

Start: Nov 2009Est. completion: Aug 201089 patients
Phase 4Completed
NCT00828906AlconDuoTrav

DuoTrav® Eye Drops As Replacement Therapy Program

Start: Feb 2009128 patients
Phase 4Completed
NCT00887029AlconDuoTrav

A 12 Week Comparison of DuoTrav and Xalacom in Open-Angle Glaucoma

Start: Jan 2009Est. completion: Nov 200954 patients
Phase 4Completed
NCT00798759AlconTravoprost ophthalmic solution 0.004% with SofZia® preservative system

Examination of Ocular Surface Effects With Administration of Travatan Z and XALATAN

Start: Dec 2008Est. completion: May 2009236 patients
Phase 4Completed
NCT00759239AlconTravoprost 0.004% / Timolol maleate 0.5%

Phase IV Randomised Double-masked Clinical Trial: Assessing Morning Versus Evening Dosing of a Fixed Dose Combination of Travoprost 0.004% / Timolol Maleate 0.5% in Patients With Primary Open-angle Glaucoma or Ocular Hypertension

Start: Sep 2008Est. completion: Jan 201136 patients
Phase 4Completed
NCT00541242AbbViebimatoprost

Safety and Efficacy of Bimatoprost Compared With Latanoprost in Patients With Glaucoma or Ocular Hypertension

Start: Dec 2007Est. completion: Aug 2008586 patients
Phase 4Completed
NCT00508469AlconTravoprost 0.004%/timolol 0.5% fixed combination eye drops

Adherence Assessment With Travalert Dosing Aid

Start: Oct 2007Est. completion: Jan 2010102 patients
Phase 4Completed
NCT00539526AbbViebimatoprost

Evaluation of Hyperemia With the Use of Ocular Prostaglandin Analogues

Start: Sep 2007Est. completion: Sep 2008106 patients
Phase 4Completed
NCT00527592AlconTravoprost ophthalmic solution 0.004% with SofZia® preservative system

A Single Dose Comfort Comparison of Travatan Z in One Eye Versus Xalatan in the Opposite Eye in Patients With Primary Open-Angle Glaucoma or Ocular Hypertension

Start: May 2007Est. completion: Aug 200854 patients
Phase 4Completed
NCT00471068AlconTravatan

Study of Travatan and Cosopt in Primary Open-Angle Glaucoma or Ocular Hypertension

Start: Mar 200746 patients
Phase 4Terminated
NCT00457795AbbViebrimonidine 0.1%

24-hour IOP-lowering Effect of Brimonidine 0.1%

Start: Dec 2006Est. completion: Feb 200915 patients
Phase 4Completed
NCT00440011AbbViebimatoprost

Bimatoprost 0.03% Versus Travoprost 0.004% in Patients Currently on Latanoprost 0.005%

Start: Aug 2006Est. completion: Oct 2007266 patients
Phase 4Completed
NCT00822055AbbViebrimonidine tartrate 0.2%/timolol maleate 0.5% fixed combination

Comparison of the Fixed Combinations of Brimonidine/Timolol and Dorzolamide/Timolol in Subjects With Open-Angle Glaucoma or Ocular Hypertension

Start: May 2005Est. completion: Nov 2006140 patients
Phase 4Completed
NCT00224289Pfizerlatanoprost

Effect of Age on Latanoprost 0.005% in Patients With Glaucoma

Start: Mar 2005Est. completion: Apr 200917 patients
Phase 4Completed
NCT00822081AbbViebrimonidine tartrate 0.2%/timolol maleate 0.5% fixed combination

Comparison of the Fixed Combinations of Brimonidine/Timolol and Dorzolamide/Timolol in Subjects With Open-Angle Glaucoma or Ocular Hypertension

Start: Jan 2005Est. completion: Apr 2006140 patients
Phase 4Completed

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Phase Legend

Preclinical— Lab & animal studies
Phase 1— Safety & dosing
Phase 2— Efficacy testing
Phase 3— Large-scale trials
On Market— Approved & available

Key Insights

36 late-stage (Phase 3) programs, potential near-term approvals
1 actively recruiting trials targeting 9,089 patients
16 companies competing in this space

Related Indications

Glaucoma(223)Cataract(220)Myopia(162)Dry Eye(154)Age-Related Macular Degeneration(149)Neovascular Age-related Macular Degeneration(113)Dry Eye Disease(106)Dry Eye Syndromes(86)Macular Degeneration(76)Diabetic Retinopathy(74)

The information on this page is for informational purposes only and should not be used as a substitute for professional medical advice. Drug information is sourced from FDA, DailyMed, and other government databases. Adverse event data from FAERS does not establish causation. Always consult a healthcare professional for medical decisions.