Open Angle Glaucoma Treatment Preferences of Glaucoma Specialists in the United States

This cross-sectional survey study evaluated the current treatment preferences of US glaucoma specialists for open angle glaucoma, finding that most preferred selective laser trabeculoplasty over topical medications for treatment-naive patients with ocular hypertension and open angle glaucoma.

To describe US glaucoma specialists' preferences regarding the use of selective laser trabeculoplasty (SLT) versus topical glaucoma medications for the treatment of open angle glaucoma.

Actively practicing glaucoma specialists from the American Glaucoma Society were invited to participate in a survey assessing treatment preferences and influencing factors. Multivariable logistic regressions were performed to determine predictors of preference for SLT.

Of 136 eligible respondents, 65%-71% preferred SLT for treatment-naive patients with ocular hypertension, mild-to-moderate primary open angle glaucoma (POAG), pseudoexfoliation glaucoma, or pigmentary glaucoma. For mild-to-moderate POAG on one medication, 75% of respondents favored SLT. For advanced POAG on maximum medical therapy, 57% of respondents favored surgery and 38% preferred SLT. Respondents indicated that reducing medication nonadherence (93%), suitable glaucoma type or stage (88%), and experience performing SLT (83%) were key facilitators in recommending SLT to their patients. In contrast, patients' inability to position for the procedure (78%), unsuitable glaucoma type or stage (67%), and comorbidities or contraindications to SLT (55%) were primary reasons to not recommend SLT. Physicians in private practice, those who completed fellowship training more recently, and those who see more treatment-naive glaucoma patients were significantly more likely to prefer SLT over medication.

The majority of US glaucoma specialists report a preference for SLT over medication for open angle glaucoma treatment, demonstrating that acceptance of SLT has increased over the past several years, especially for treatment-naïve patients. Statistically significant predictors of SLT preference were practice setting, practice duration, and patient volume.