• Assessing Practice Preferences in Glaucoma Surgery

    Written By: Jean Shaw
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    Journal of Glaucoma
    2017;26(8):687-693

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    How have practice patterns changed among glaucoma surgeons during the past 20 years? Vinod et al. set out to assess glaucoma surgical trends, as reported by members of the American Glaucoma Society (AGS). The results confirm that the trend away from trabeculectomy and toward the use of glaucoma drainage devices (GDDs) continues in most clinical settings.

    For this study, the researchers created an anonymous online survey and distributed it via email to AGS members who subscribe to the AGS-net. Participants were asked about their practice location and date of glaucoma fellowship training; in addition, they were asked to report on their preferred approach for a set of common clinical scenarios. The data were then compared with the results from previous surveys (conducted in 1996, 2002, and 2008).

    All told, 252 (23%) of the 1,091 sub­scribers to the AGS-net participated in this survey. A majority (59%) reported that they are in private practice, while the remainder practice in an academ­ic setting. Most had completed their fellowship training either ≥ 20 years ago (33%) or ≤ 5 years ago (29%).

    When the results were analyzed by practice setting, no significant differ­ences emerged between surgeons in private and academic settings regarding any given surgical technique in any clinical scenario. However, differences did emerge when years of surgical expe­rience were factored in: Older surgeons were more likely to use trabeculectomy with mitomycin-C (MMC) in several clinical scenarios, while their younger counterparts preferred GDDs.

    Overall, the respondents preferred to use GDDs in 7 of the 8 clinical scenar­ios presented. This represents nearly a complete reversal from the results of the 1996 survey, in which trabeculec­tomy was selected most frequently to manage glaucoma in all clinical scenarios presented, the authors noted. The results also indicate that GDDs are being used more frequently in eyes at low risk for filtration failure.

    A new question—on combined cataract/glaucoma surgery and min­imally invasive glaucoma surgery (MIGS)—was added to this iteration of the survey. When given the scenario of a patient with cataract and primary open-angle glaucoma, 44% of the re­spondents reported that they would use phacoemulsification alone, 24% would combine phaco with trabeculectomy/MMC, 22% would perform phaco with MIGS, and 9% would perform phaco and implant a GDD.

    The original article can be found here.