Trends in First-Line Glaucoma Treatment from 2013 to 2024: A Multi-institutional and Multinational Cohort Study.

Area of Science:

• Ophthalmology
• Public Health
• Health Services Research

Background:

• Glaucoma is a leading cause of adult blindness globally.
• Understanding current first-line treatment patterns is crucial for managing glaucoma.
• Contemporary treatment strategies require updated insights.

Purpose of the Study:

• To analyze trends in first-line glaucoma treatment over a 12-year period.
• To compare treatment patterns for open-angle glaucoma (OAG) and angle-closure glaucoma (ACG).
• To identify shifts in medication, surgery, and laser therapy use.

Main Methods:

• Retrospective cohort study using electronic health records (2013-2024).
• Included patients aged ≥40 years with OAG or ACG diagnoses.
• Assessed monotonic trends using Mann-Kendall tests, reporting Kendall's τ and Q values.

Main Results:

• In OAG, medication use decreased (91.0% to 85.8%), while surgery increased (4.8% to 9.0%).
• Laser therapy remained stable in OAG (4.2% to 5.2%).
• In ACG, medication use increased (72.4% to 88.6%), with significant declines in surgery (9.8% to 2.6%) and laser therapy (17.8% to 8.8%).

Conclusions:

• Medication remains the primary first-line treatment for both OAG and ACG.
• Treatment patterns show a trend towards increased surgery for OAG and greater medication reliance for ACG.
• Further research is needed to evaluate long-term outcomes and guide subtype-specific glaucoma management.