Risk factors for undergoing surgery in patients with newly diagnosed open-angle glaucoma

Abstract

Despite the clinical importance of glaucoma surgery, studies on its prevalence and risk factors are limited. We analyzed a database comprising approximately 1,000,000 Korean residents to investigate the prevalence and risk factors for undergoing glaucoma surgery within 5 years of diagnosis with open-angle glaucoma. Of the 4,303 patients evaluated, 226 (5.3%) underwent glaucoma surgery. Factors associated with the likelihood of glaucoma surgery included the use of two or more eye drops (odds ratio [OR], 30.30; 95% confidence interval [CI], 10.95–83.84), intake of oral carbonic anhydrase inhibitor (OR, 1.79; 95% CI, 1.23–2.61), age > 55 years (55–65 years: OR, 1.71; 95% CI, 1.06–2.76; > 65 years: OR 1.72; 95% CI, 1.10–2.70), female sex (OR, 1.46; 95% CI, 1.10–1.94), middle- and high-income (OR, 2.36; 95% CI, 1.30–4.28, OR, 1.86; 95% CI, 1.03–3.35, respectively), and metropolitan residence (OR, 1.61; 95% CI, 1.14–2.26). Our nomogram for predicting the likelihood of glaucoma surgery showed an acceptable result. In conclusion, older age, female sex, and the intensity of intraocular pressure lowering treatment increased the likelihood of undergoing glaucoma surgery. Our findings indicated that a lower socioeconomic status may forestall receiving this necessary surgery, which requires further attention.

Incidence of glaucoma filtration surgery from disease onset of open‐angle glaucoma

“…A similar trend in procedure types was reported in the United States associated with the advent of MIGS since 2012 (Boland et al., 2021). A Korean healthcare insurance claims database study reported a 5‐year surgery rate of 5.3% in newly diagnosed OAG patients (Lee et al., 2022). Similarly, a US claims database study investigating treatment patterns in the first 4 years of OAG reported a cumulative incidence of 5.1% (Schwartz et al., 2021).…”

“…In comparison, the Korean cohort gathered data from 2004 to 2010 of 4560 OAG patients, while the US data from 2007 to 2014 encompassed 6172 OAG patients. Secondly, for case identification we used a medication reimbursement database distinct from studies utilizing hospital billing claims data (Kansal et al., 2020; Lee et al., 2022; Schwartz et al., 2021). Our definition for OAG entails a thorough clinical and administrative process of medication reimbursement claims adhering to standardized criteria effectively precluding glaucoma suspects with inconclusive findings.…”

“…Few studies have investigated factors associated with the risk of OAG patients undergoing GFS. Regional practice preferences and demographic and socioeconomic factors may influence the availability, access, and choice of glaucoma care, while certain patient‐related characteristics, such as medication, comorbidities, age, and sex, may determine the probability of receiving surgical treatment (Lee et al., 2022; Shirai et al., 2021). Epidemiological knowledge of the cumulative risk of GFS would inform patients and provide prognostic tools for clinicians and healthcare policymakers to optimize glaucoma care and assess the need for surgical services at population level.…”

Microfluidics in the eye: a review of glaucoma implants from an engineering perspective

“…On average, it is estimated that there are 139.2 ± 113.1 glaucoma surgeries performed per million population, and 5.3% of glaucoma patients are likely to receive surgical treatments within five years of their diagnosis. 21 Presently, trabeculectomy is the gold standard for glaucoma surgery, 22,23 which forms a scleral fistula to drain the AH towards the subconjunctival space (outside sclera and beneath conjunctiva), resulting in a filtering bleb. 18,24 Despite its operational simplicity, it is associated with a high rate of complications, 25 a high rate of surgical failure, 26 a high reoperation frequency ( e.g.…”

“…21 Presently, trabeculectomy is the gold standard for glaucoma surgery, 22,23 which forms a scleral fistula to drain the AH towards the subconjunctival space (outside sclera and beneath conjunctiva), resulting in a filtering bleb. 18,24 Despite its operational simplicity, it is associated with a high rate of complications, 25 a high rate of surgical failure, 26 a high reoperation frequency ( e.g. , 29% within five years), 27 and intensive postoperative management.…”