Reasons for choice of glaucoma surgery in eyes not treated with anti-glaucoma medications

Abstract

Background In the real world, some glaucoma patients can undergo an incisional glaucoma surgery without using medication. The rate of cases with no medication treatment at the time of surgery among those that underwent incisional glaucoma surgeries performed in our department was reported. Methods The department database of Shimane University Hospital for eyes that underwent incisional surgeries to manage glaucoma at the hospital between April 2018 and September 2020 were searched. By reviewing the medical charts of 1,417 consecutive eyes listed, 90 (6.4%) eyes of 67 subjects (mean age of 72 ± 16 years; 22 men, 29 eyes; 45 women, 61 eyes) who underwent a surgery without use of antiglaucoma medication were identified. The types of glaucoma, glaucoma procedures, and reasons for choosing the glaucoma surgeries rather than medical therapy were collected for the 90 eyes. Results Among the 90 eyes, primary angle-closure disease (PACD) (60%) was the most frequent type of glaucoma followed by EXG (17%), POAG (16%), and others (8%). Among the reasons for the choice of incisional surgery, relief of angle closure (64%) was the most frequent, the second most frequent was the incidental diagnosis of glaucoma during the ocular examinations both for that eye’s cataract surgery or the contralateral glaucoma surgery (13%). Other reasons included poor medication adherence (10%), dementia (6%), multiple medication allergy (3%), and acute IOP elevation other than PACD (3%). Cataract extraction (CE) alone (33%) was the most frequent glaucoma procedures performed in these eyes, followed by CE combined with goniosynechialysis (27%), CE + iStent (16%), CE + goniotomy by Tanito microhook ab interno trabeculotomy or using the Kahook Dual Blade (11%), Ahmed Glaucoma valve implantation (11%), and trabeculectomy (2%). Conclusion In the real-world, 6.4% of incisional glaucoma surgeries were performed in the absence of medication use; of them, 32 eyes (2.3%) were with open angle glaucoma. In open angle glaucoma, the reasons can be classified into; 1) patients’ inability to instill the medication, 2) incidental diagnosis of glaucoma during the pre-surgical examinations, and 3) the eyes with acute IOP rise.

Nationwide Analysis of Glaucoma Surgeries in Fiscal Years of 2014 and 2020 in Japan

“…The Japanese health system remunerates for each procedure, and thus, other than based on the clinical evidence, decisions according to remuneration opportunity might drive the recent increase in glaucoma procedures to some degree. Recent reports from Japan suggested that combined MIGS and cataract surgery could be chosen in glaucoma patients who had not been treated with medication [35]. The study site of that report was the tertiary care hospital of the prefecture that had the lowest population, and the patients were referred from far and wide.…”

Access to Eye Care Providers and Glaucoma Severity in the National Institutes of Health All of Us Research Program

“…These findings are likely explained by the fact that one must have access to an eye care provider to undergo a surgical procedure. A retrospective cohort study by Sugihara et al 14 found that an incidental diagnosis of glaucoma during ophthalmic examination before cataract surgery, as well as an acute intraocular pressure elevation before glaucoma diagnosis, were associated with an increased likelihood of incisional glaucoma surgery. The study hypothesized that once these individuals became aware of their condition, they were more likely to have follow-up care and undergo surgical intervention when indicated.…”

Nation-Wide Analysis of Glaucoma Medication Prescription in Fiscal Year of 2019 in Japan

“…To date, analysis of glaucoma medication prescription was conducted by nationwide studies using the database from medical insurance claims of hospitals and pharmacies, or from a large-scale cohort study [ 3 , 4 , 5 , 6 ]. The trends of medication prescription have been changed by various factors such as the appearance of new medication classes and regimens [ 4 , 5 , 7 , 8 ], the appearance of alternative treatments other than medication [ 9 , 10 , 11 ], or an increase of the glaucoma patients and aged population [ 4 , 12 , 13 ]. Therefore, continuing updates for the database and its analysis are required to understand the current status of glaucoma medication usage.…”