Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) Differ by Glaucoma Type: IRIS Registry Analysis...

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Glaucoma surgery involves standard procedures like trabeculectomy or glaucoma drainage devices (GDDs) and newer minimally invasive glaucoma surgery (MIGS) techniques.
• Understanding the adoption patterns and comparative effectiveness of these surgical approaches is crucial for optimizing patient care.

Purpose of the Study:

• To analyze the utilization trends of standard versus MIGS procedures in the United States.
• To investigate how glaucoma diagnosis type influences the selection of surgical interventions, including concurrent and sequential procedures.

Main Methods:

• Utilized the American Academy of Ophthalmology IRIS® Registry data from 2013-2018.
• Calculated cumulative proportions of different glaucoma surgical techniques (stand-alone, concurrent, sequential) based on glaucoma diagnosis.
• Performed secondary analyses of adjusted proportions stratified by glaucoma type.

Main Results:

• Open angle glaucoma (OAG) was most frequently treated with all surgical types.
• iStent was the most common MIGS, particularly for normal tension glaucoma (NTG) and OAG.
• Glaucoma drainage devices (GDDs) were prevalent in secondary or other specified glaucoma types.
• Trabeculectomy or GDDs were the most common initial surgeries, with a high rate of subsequent standard interventions.
• Ab interno canaloplasty (ECP) was the most frequent MIGS performed after initial standard surgery, especially in primary angle-closure glaucoma (PACG) and secondary glaucoma.

Conclusions:

• Glaucoma type significantly impacts the choice between standard and MIGS procedures, as well as the decision for concurrent or sequential surgeries.
• The long-term safety and effectiveness of MIGS compared to standard interventions require further investigation across various glaucoma types.