Practice Patterns and Challenges of Glaucoma Specialists in Achieving Optimal Management for Glaucoma in India:...

Glaucoma is one of the leading causes of irreversible blindness in India.

This study aimed to explore the current paradigms of glaucoma management among specialists in India and understand patterns of care, barriers to access, and challenges faced by treating physicians.

It is a cross-sectional questionnaire national survey.

An online questionnaire was distributed to the members of the Glaucoma Society of India, assessing demographic data, practice settings, diagnostic equipment availability, clinical evaluation methods, treatment approaches, postoperative modification, and postoperative complications. Comparisons were made between different practice settings (government, private, non-governmental organizations (NGO)) and between specialists with long-term (>4 months) fellowship training. The chi-squared test was used to determine statistical significance.

Of 159/700 respondents (22.7% response rate), 101 (63.5%) were women. Practice distribution included private practice, 91 (57.2%), NGO/trust hospital, 38 (23.98%), and government settings, 27 (17.02%). Sixty-eight (53.5%) had done a long-term fellowship (>4 months), 16 (12.6%) had done a short-term fellowship (<4 months), and 35 (27.6%) had not done any fellowship. Most specialists had access to Goldmann applanation tonometers, 131 (82.1%), and optical coherence tomography (OCT), 120 (75.5%), but selective laser trabeculoplasty (SLT) availability was limited, 36 (22.5%). Fundus photography (p=0.039) was more frequently performed in private and NGO centers as compared to government hospitals, while Schiotz tonometer (p=0.039) was used more frequently in government facilities. Long-term fellowship-trained specialists performed gonioscopy significantly more often than non-fellowship-trained specialists (65% and 96% vs. 19% and 63.5%; p<0.001). Medical management was preferred by 143 (91.7%), with prostaglandin analogues as first-line treatment by 119 (83.2%). Major patient-related challenges reported included financial constraints, 98 (61.5%), patient knowledge gaps, 98 (61.5%), treatment non-compliance, 96 (60.3%), and late diagnosis due to advanced presentation, 92 (58.3%).

While most Indian glaucoma specialists follow standard practice guidelines, variations exist based on training background and practice setting. Specialized fellowship training significantly improves adherence to best practices.