Trends in Glaucoma Surgeries Performed by Glaucoma Subspecialists versus Nonsubspecialists on Medicare Beneficiaries from 2008 through 2016

Purpose To quantitatively evaluate the inter-annotator variability of clinicians tracing the contours of anatomical layers of the iridocorneal angle on digital gonio photographs, thus providing a baseline for the validation of automated analysis algorithms. Methods Using a software annotation tool on a common set of 20 images, five experienced ophthalmologists highlighted the contours of five anatomical layers of interest: iris root (IR), ciliary body band (CBB), scleral spur (SS), trabecular meshwork (TM), and cornea (C). Inter-annotator variability was assessed by (1) comparing the number of times ophthalmologists delineated each layer in the dataset; (2) quantifying how the consensus area for each layer (i.e., the intersection area of observers’ delineations) varied with the consensus threshold; and (3) calculating agreement among annotators using average per-layer precision, sensitivity, and Dice score. Results The SS showed the largest difference in annotation frequency (31%) and the minimum overall agreement in terms of consensus size (∼28% of the labeled pixels). The average annotator's per-layer statistics showed consistent patterns, with lower agreement on the CBB and SS (average Dice score ranges of 0.61–0.7 and 0.73–0.78, respectively) and better agreement on the IR, TM, and C (average Dice score ranges of 0.97–0.98, 0.84–0.9, and 0.93–0.96, respectively). Conclusions There was considerable inter-annotator variation in identifying contours of some anatomical layers in digital gonio photographs. Our pilot indicates that agreement was best on IR, TM, and C but poorer for CBB and SS. Translational Relevance This study provides a comprehensive description of inter-annotator agreement on digital gonio photographs segmentation as a baseline for validating deep learning models for automated gonioscopy.

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“… 4 Gonioscopy is thus fundamental to assessing the status of the ICA and identifying eyes with, or at risk of, angle closure. 5 , 6…”

Section: Introductionmentioning

confidence: 99%

On Clinical Agreement on the Visibility and Extent of Anatomical Layers in Digital Gonio Photographs

Peroni

Paviotti²,

Campigotto³

et al. 2021

Trans. Vis. Sci. Tech.

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“…Recent years have witnessed a marked rise in the use of MIGS procedures as an earlier intervention prior to (or ideally instead of) filtering procedures. 5 MIGS procedures seek to avoid the disadvantages of ocular hypotensive medication (eg, ocular surface disease, poor compliance, side effects, cost) and the risks of filtering surgeries (eg, dysesthesia, bleb leaks, hypotony, blebitis, and lifetime endophthalmitis risk). [6][7][8][9][10] To-date, the most extensive body of MIGS evidence pertains to the first US Food and Drug Administration (FDA)-approved MIGS device, the Glaukos iStent ® Trabecular Micro-Bypass.…”

Section: Introductionmentioning

confidence: 99%

Treatment Success Across Different Levels of Preoperative Disease Burden: Stratified Two-Year Outcomes from the Pivotal Trial of iStent inject® Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract

Singh¹,

Sarkisian²,

Hornbeak³

et al. 2021

OPTH

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Purpose: To examine effectiveness outcomes stratified by preoperative disease burden in the pivotal trial of iStent inject ® with cataract surgery (INJ) vs cataract surgery alone (CS). Materials and Methods: Prospective, 3:1 randomized, single-masked, concurrentlycontrolled, multicenter trial enrolling 505 subjects with cataract and mild-to-moderate primary open-angle glaucoma who underwent iStent inject implantation with phacoemulsification or phacoemulsification alone, and were followed for 2 years including annual medication washouts. Post hoc stratification was completed for baseline mean diurnal intraocular pressure (BL DIOP; Low-DIOP <25mmHg, Mid-DIOP ≥25 to <30 mmHg, High-DIOP ≥30mmHg) and preoperative medication burden (Low-Med 1 medication, Mid-Med 2 medications, High-Med ≥3 medications). Results: The 24-month primary and secondary effectiveness endpoints were met, with significant treatment-over-control differences in percent of eyes achieving ≥20% unmedicated DIOP reduction and in unmedicated DIOP reduction, respectively. In subgroup analyses, the proportions of INJ eyes achieving the primary endpoint remained steady across all BL DIOP (75.4%, 77.1%, 74.4% in Low/Mid/High-DIOP strata, respectively) and preoperative medication levels (76.8%, 70.8%, 79.7% in Low/Mid/High-Med strata, respectively); meanwhile, the proportions of CS eyes diminished with higher BL DIOP (64.5%, 63.6%, 33.3%, respectively) and more medications (69.0%, 63.3%, 29.4%, respectively). Regarding secondary effectiveness, postoperative DIOP reduction increased with higher BL DIOP in INJ eyes (6.2mmHg, 7.8mmHg, 9.8mmHg, respectively) but plateaued in CS eyes (5.2mmHg, 5.8mmHg, 5.4mmHg, respectively). INJ eyes also had consistent DIOP reduction regardless of preoperative medication burden (6.8mmHg, 6.7mmHg, 7.8mmHg, respectively), while DIOP reduction diminished with more medications in CS eyes (6.1mmHg, 5.0mmHg, 3.3mmHg, respectively). Safety was favorable, comparable to phacoemulsification alone. Conclusion: Significant IOP reductions occurred across all levels of BL DIOP and preoperative medication burden in iStent inject eyes. DIOP reductions increased with higher BL DIOP and remained stable across all levels of preoperative medication burden, suggesting the device's potential utility in more medically challenging cases.

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“…13 This evolving practice pattern has been observed worldwide, with increasing rates of tube shunt surgeries relative to trabeculectomy found in American, British and Canadian studies. [14][15][16][17] Most recently in United States, from 2008 to 2016 the overall number of trabeculectomies performed on fee-for-service Medicare patients decreased from 25,610 in 2008 to 18,925 in 2016, while there was a 20.2% increase in the number of tube shunt surgeries from 11,615 in 2008 to 13,960 in 2016. 15 In the United Kingdom, rates of trabeculectomy remained relatively stable from 2003 to 2012 at 9.06 to 10.76 per 100,000 persons, whilst tube shunt insertions increased six-fold from 0.3 per 100,000 in 2012 compared to 1.88 per 100,000 persons in 2003, with the highest increase in those aged older than 60.…”

Section: Discussionmentioning

confidence: 99%

Changing trends in glaucoma surgery within Australia

et al. 2021

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BackgroundLimited data are available on glaucoma surgical trends in Australia.MethodsNationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals.ResultsAlthough there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p<0.001 for both). When stratified by age group, there was a statistically significant interaction in both trabeculectomy and GDD rates by age groups over time (p<0.001 for both). Trabeculectomy procedures decreased to a greater extent in those aged >60 years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups.ConclusionOur findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.

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Trends in Glaucoma Surgeries Performed by Glaucoma Subspecialists versus Nonsubspecialists on Medicare Beneficiaries from 2008 through 2016

Cited by 71 publications

References 26 publications

On Clinical Agreement on the Visibility and Extent of Anatomical Layers in Digital Gonio Photographs

On Clinical Agreement on the Visibility and Extent of Anatomical Layers in Digital Gonio Photographs

Treatment Success Across Different Levels of Preoperative Disease Burden: Stratified Two-Year Outcomes from the Pivotal Trial of iStent inject® Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract

Changing trends in glaucoma surgery within Australia

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