Variations in Trabeculectomy and Glaucoma Drainage Device Use for the Treatment of Glaucoma in the United States

Khanna, Cheryl L.; Mahr, Michael A.; Hodge, David O.; Khanna, Sunil S.; Erie, Jay C.

doi:10.1016/j.ogla.2018.08.005

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…A recent Medicare database study performed by Khanna et al demonstrated high geographical variation in preference between trabeculectomy and GDI placement. 24 Their study, based on data from 2014, demonstrated that GDI was used significantly more frequently than trabeculectomy within the South and Midwest regions relative to the Northeast. Our findings corroborate their results in that the Southeast and Southwest have the highest GDI surgery rates per capita.…”

Section: Discussionmentioning

confidence: 99%

“…Determinants of regional variations are likely multifactorial, and may be influenced by patient demographics and socioeconomic conditions, academic institutions which serve as investigational sites for studies, as well as the rigor and locale of training for regional physicians, who are mentored and taught similar techniques and preferences. 24 Further studies performed on unified databases containing patient demographic and clinical data may elucidate more of the underlying drivers why MIGS adoption is faster in certain states than others.…”

Section: Discussionmentioning

confidence: 99%

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<p>GlaucoMap – Distribution of Glaucoma Surgical Procedures in the United States</p>

Anthony

Lee

Warren

et al. 2020

OPTH

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Purpose: To understand the distribution of trabeculectomies, glaucoma drainage implants (GDI) and micro-invasive glaucoma surgeries (MIGS) performed in the United States through geospatial mapping. Methods: We performed an observational cohort study to evaluate glaucoma surgeries in patients age ≥65. The most recently released data from Centers for Medicare Part B Carrier Summary Files were queried to determine the number of glaucoma surgeries performed per state during the year of 2017. We created choropleth maps, titled "GlaucoMap", to characterize the rates of various surgeries performed across the United States, defined as the number of procedures performed per 10,000 individuals. A chi-squared analysis was further used to evaluate differences in surgical preferences across geographic region. Standardized residuals (SR) were calculated to determine regional influences on surgical distribution. Results: There were 174,788 glaucoma surgeries performed: 22,862 trabeculectomies (13.1%), 19,991 GDI (11.4%) and 131,935 (75.5%) MIGS. The Northeast had the highest trabeculectomy rate, GDI was highest in the Southeast and MIGS were highest in the Southwest. There was a statistically significant difference in proportional use of conventional surgeries versus MIGS across various regions in the United States (p < 0.0001). Given the high trabeculectomy and GDI rates and relatively low MIGS adoption in the Southeast, we observed a +7.03 SR for conventional surgeries and −4.01 SR for MIGS. The Southwest and Western states had the highest MIGS rate and contributed +3.29 and +3.24 SR toward disproportional MIGS preference, respectively. The preference for conventional surgeries in the Northeast (SR = +2.93) and MIGS in the Midwest (SR = +0.99) also contribute to the overall differences in glaucoma surgeries across the United States. Conclusion: GlaucoMap is useful for visualizing the distribution of glaucoma surgeries in the United States. The heterogeneity in surgical preferences points to regional differences in glaucoma management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>GlaucoMap – Distribution of Glaucoma Surgical Procedures in the United States</p>

Anthony

Lee

Warren

et al. 2020

OPTH

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“…However, recent randomized trials revealed its efficacy and survival are comparable to trabeculectomy [7,8]. The United States medical insurance claims data demonstrated a marked increase in GDD implantation over the last decade [9]. Despite its continuous growth, postoperative complications, including hypotony, conjunctival erosion, cataract, and endophthalmitis, may occur following GDD surgery [10].…”

mentioning

confidence: 99%

Effect of Head Position and Tube Entry on Corneal Endothelial Cells in Patients with Glaucoma Drainage Implants: A Cross-sectional Study

Han

Yoo

Park

et al. 2020

Korean J Ophthalmol

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Currently, reduction of intraocular pressure (IOP) is the only proven treatment for glaucoma [1]. IOP reduction can be achieved with medication, laser, or surgery. Surgical treatment for glaucoma includes trabeculectomy, glaucoma drainage device (GDD) implantation, trabecular bypass stents, ab interno trabeculectomy, and subconjunctival stenting [2-6]. The emergence of minimally invasive glaucoma surgery has broadened the scope of surgical alterna-Purpose: To investigate the effect of head tilt on the tube position of the Ahmed glaucoma valve (AGV) implanted in patients with glaucoma and to assess how the head tilt-induced alterations of tube parameters and the level of tube entry influence corneal endothelial cell density (ECD). Methods: A total of 29 eyes of 26 patients with AGV implantation were included. Tube-cornea distance, tube-cornea angle, and intracameral tube length were measured using anterior segment optical coherence tomography in three different head positions (neutral, 30° temporalward tilt, and 30° nasalward tilt). The tube entry was assessed using static gonioscopy. ECD was measured using specular microscopy before and after surgery. Results: The mean tube-cornea distance, tube-cornea angle, and intracameral tube length (neutral: 0.87 ± 0.39 mm, 30.56 ± 5.89˚, and 3.10 ± 0.82 mm, respectively) decreased with head tilts (temporalward: 0.82 ± 0.39 mm, 29.27 ± 5.82˚, and 3.04 ± 0.82 mm, respectively; nasalward: 0.83 ± 0.40 mm, 29.61 ± 6.04˚, and 3.05 ± 0.81 mm, respectively; all p < 0.01). The multivariate analyses found age and the tube insertion level to be associated with postoperative changes in the central ECD (p = 0.039 and 0.013, respectively), and the postoperative follow-up period and tube insertion level to be associated with the difference between the inferonasal and superotemporal ECDs (p = 0.034 and 0.007, respectively). Conclusions: Mild alterations of head positions induced changes in the intracameral tube positions of AGV implants; nevertheless, it did not significantly affect ECD loss. However, the eyes with tubes inserted anteriorly to Schwalbe's line may be more susceptible to corneal ECD loss.

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Personalising surgical treatments for glaucoma patients

Mégevand¹,

Bron

2021

Progress in Retinal and Eye Research

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Variations in Trabeculectomy and Glaucoma Drainage Device Use for the Treatment of Glaucoma in the United States

Cited by 3 publications

References 12 publications

<p>GlaucoMap – Distribution of Glaucoma Surgical Procedures in the United States</p>

<p>GlaucoMap – Distribution of Glaucoma Surgical Procedures in the United States</p>

Effect of Head Position and Tube Entry on Corneal Endothelial Cells in Patients with Glaucoma Drainage Implants: A Cross-sectional Study

Personalising surgical treatments for glaucoma patients

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