In a recent study published in the Journal of Glaucoma, researchers explored which factors may impact ophthalmologists’ choice of using laser trabeculoplasty vs topical therapy for primary open-angle glaucoma (POAG).
Give me some background first.
POAG is a common form of glaucoma that impacts an estimated 95% of individuals with the disease. Potential risk factors for this subset include:
- High eye pressure
- Family history of glaucoma
- Thin cornea
- Aged 40+ and African American
- Aged 60+ for the general population
- Particularly so for Mexican Americans
Now, talk about the study.
Researchers conducted a 33-question survey that was distributed to an American Society of Cataract and Refractive Surgery database on treatment choices made by ophthalmologists for POAG.
The data they collected in the survey included:
- Country of practice
- Years of practice
- Completion of glaucoma fellowship training
- Type of practice
- Preference for first line of treatment of POAG
Then: They utilized multiple logit regression to compare the effect of covariates on ophthalmologists' choice of either topical medication or laser trabeculoplasty for POAG.
How many survey respondents were there?
Out of 19,246 surveys, a total of 252 (1.3%) of surveys were returned.
Findings?
It was found that:
- 73.6% of respondents utilized topical medication as first line of treatment for POAG
- 26.4% of respondents preferred to start with laser treatment
Why did some respondents choose laser over topical medication?
Significant variables associated with the selection of laser treatment over topical medications were:
- Practicing in the U.S.
- Odds ratio (OR) 2.85, 95% confidence interval (CI) 1.33-6.10
- More recent completion of ophthalmology residency
- OR 1.95, 95% CI 1.00-3.77
- Greater volume of minimally-invasive glaucoma surgeries (MIGS)
- OR 1.68, 95% CI 1.18-2.40
- A glaucoma patient base greater than 25%
- OR 2.21, 95% CI 1.09-4.48
Limitations?
A potential limitation of this study may have been the low number of survey respondents.
Expert opinion?
The authors stated, “The results of this survey demonstrate a continuing unmet need to educate our colleagues on evidence-based treatment results for POAG.”
Take home.
The study found that newly practicing ophthalmologists who perform more MIGS and have a larger glaucoma patient base preferred laser trabeculoplasty for first-line treatment of POAG versus topical drops.