Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society

Abstract

Purpose To assess surgical practice patterns among the American Glaucoma Society (AGS) membership. Methods An anonymous online survey evaluating the use of glaucoma surgeries in various clinical settings was redistributed to AGS members. Survey responses were compared with prior results from 1996, 2002, and 2008 to determine shifts in surgical practice patterns. Questions were added to assess the preferred approach to primary incisional glaucoma surgery and phacoemulsification combined with glaucoma surgery. Results A total of 252 of 1,091 (23%) subscribers to the AGS-net participated in the survey. Percentage use (mean ± SD) of trabeculectomy with mitomycin C (MMC), glaucoma drainage device (GDD), and minimally-invasive glaucoma surgery (MIGS) as an initial surgery in patients with primary open angle glaucoma (POAG) was 59% ± 30%, 23% ± 23%, and 14% ± 20%, respectively. Phacoemulsification cataract extraction alone was the preferred surgical approach in 44% ± 32% of patients with POAG and visually significant cataract, and phacoemulsification cataract extraction was combined with trabeculectomy with MMC in 24% ± 23%, with MIGS in 22% ± 27%, and with GDD in 9% ± 14%. While trabeculectomy was selected most frequently to surgically manage glaucoma in 8 of 8 clinical settings in 1996, GDD was preferred in 7 of 8 clinical settings in 2016. Conclusions The use of GDD has increased and that of trabeculectomy has concurrently decreased over the past 2 decades. Trabeculectomy with MMC is the most popular primary incisional surgery when performed alone or in combination with phacoemulsification cataract extraction. Surgeons frequently manage coexistent cataract and glaucoma with cataract extraction alone, rather than as a combined cataract and glaucoma procedure.

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“…Limitations of this study include a low response rate (25%). However, it is comparable to that of the historical control survey on glaucoma practice patterns by Vinod et al (23% response rate) 7,8 and responses were received from all geographic regions of the country. Another limitation is that the survey design did not allow for the distinction between 0 and 1-5 cases for the questions about number of cases residents observed, assisted, and completed as primary surgeons.…”

“…Several studies have demonstrated a decline in trabeculectomy cases and increase in glaucoma drainage device implantation over the past 10 years. [5][6][7][8][9][10] Simultaneously, there has been an increase in development and use of MIGS devices. 2,11 MIGS is becoming an important part of the surgical armamentarium for glaucoma surgery.…”

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“…Meanwhile, DS was not even mentioned in the survey which indicates that it is not one of the favorite glaucoma surgeries for glaucoma surgeons. 20 The steep learning curve is the main reason for not being a popular surgery.…”

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“…Long-term data regarding cost-effectiveness is currently inexistent. Trabeculectomy is still the cheapest surgical option amongst all glaucoma procedures and the most commonly performed procedure [ 81 , 82 ].…”

“…A survey of American Glaucoma society (AGS) published in 2017 for preferred practice preferences for the type of glaucoma surgery among AGS members has also reported that Trab MMC, GDD and MIGS constituted 59±30%, 23±23% and 14±20% respectively as an initial surgery in POAG. Although the use of GDD surgery has increased and trabeculectomy has decreased from 1996 to 2016 [ 81 ], Trab MMC was still the most popular primary glaucoma surgery among surgeons.…”