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Related Concept Videos

Glaucoma: Overview01:25

Glaucoma: Overview

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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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Open Angle Glaucoma: Treatment01:27

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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
Drugs such as carbonic anhydrase inhibitors, α2- and...
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Angle Closure Glaucoma: Treatment01:28

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Factors Associated With Gonioscopy Coding Before Glaucoma Procedures in the IRISⓇ Registry.

Daniel M Vu1, Joshua B Gilbert1, Eric A Goldberg1

  • 1From the Department of Ophthalmology (D.M.V., J.B.G., E.A.G., M.M.L., N.A.P., N.Z., C.J.R., T.E., A.C.L., J.W.M.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.

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Summary

Preoperative gonioscopy use before glaucoma surgery is lower than recommended. Microinvasive glaucoma surgeries (MIGS) showed decreased utilization, while Asian and Black patients had higher rates.

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Area of Science:

  • Ophthalmology
  • Glaucoma Management
  • Surgical Outcomes

Background:

  • Gonioscopy is crucial for diagnosing and managing glaucoma.
  • Understanding gonioscopy utilization patterns is essential for optimizing patient care.
  • The IRISⓇ Registry provides a large dataset for analyzing nationwide surgical trends.

Purpose of the Study:

  • To analyze nationwide preoperative gonioscopy utilization for glaucoma and laser surgeries.
  • To examine temporal trends in gonioscopy use over a decade.
  • To identify factors associated with gonioscopy utilization using the IRISⓇ Registry.

Main Methods:

  • Retrospective cohort study of 1.1 million adult glaucoma/laser surgeries from 2014-2023.
  • Analysis of preoperative gonioscopy within 5 years of the index glaucoma procedure.
  • Multivariable logistic regression to identify factors associated with gonioscopy use.

Main Results:

  • Preoperative gonioscopy was utilized in 63.2% of patients, with 87% within 1 year.
  • Asian and Black patients showed higher gonioscopy odds compared to White patients.
  • Microinvasive glaucoma surgeries (MIGS) had lower utilization (OR 0.67) versus traditional surgery; glaucoma subspecialists increased odds (OR 2.65).

Conclusions:

  • Preoperative gonioscopy use and/or coding is lower than expected based on guidelines.
  • Ab interno MIGS procedures are associated with reduced preoperative gonioscopy utilization.
  • Further investigation into gonioscopy adherence is warranted to improve glaucoma care standards.