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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.
American Journal of Ophthalmology
|August 9, 2025
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.
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.
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