Predictors of Initial Glaucoma Therapy with Laser Trabeculoplasty versus Medication: A Population-Based Study

Area of Science:

• Ophthalmology
• Public Health
• Health Services Research

Background:

• Glaucoma management often involves a choice between laser trabeculoplasty (LT) and topical medications as initial therapy.
• Understanding patient-level factors influencing this choice is crucial for optimizing treatment strategies and ensuring adherence to evidence-based guidelines.

Purpose of the Study:

• To investigate patient-specific characteristics associated with the selection of first-line laser trabeculoplasty (LT) compared to topical medication for glaucoma treatment.

Main Methods:

• A population-based study utilized linked health care databases in Ontario, Canada, from 2007 to 2019.
• Multivariate logistic regression analyzed associations between patient factors (age, gender, ocular history, comorbidity, socioeconomic status, residence) and the choice of LT versus medication in 194,759 patients aged 66 and older.

Main Results:

• Older age, previous ocular surgeries (cataract, corneal, retina), higher comorbidity, higher socioeconomic status, and rural residence were associated with decreased likelihood of receiving LT.
• Women were more likely than men to receive LT.
• Laser trabeculoplasty utilization increased annually over the study period.

Conclusions:

• Patient demographics, ocular history, and comorbidity significantly influence the choice of first-line glaucoma therapy, with some associations diverging from efficacy data and clinical guidelines.
• These findings underscore the complexity of treatment selection and suggest a need to re-evaluate current therapeutic approaches and guidelines for initial glaucoma management.