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Wanda Hu, Simon Law, JoAnn Giaconi; Comparison of Selective Laser Trabeculoplasty Outcomes Between Physicians-in-Training and Attending Physicians. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1868.
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To compare the outcomes of selective laser trabeculoplasty (SLT) performed by ophthalmology residents with those performed by glaucoma attendings in treating open angle glaucoma (OAG).
This is a retrospective review on patients with OAG (including primary OAG, pseudoexfoliation glaucoma, and pigmentary glaucoma) or OAG suspect who had received SLT performed by second year ophthalmology residents at a Veterans Affairs medical center compared to SLT performed by glaucoma attendings (JAG, SKL) at a tertiary care facility between 1/2008 and 6/2012 with at least 3 months of follow-up. Outcome measures included percent intraocular pressure (IOP) reduction, glaucoma medications, and additional glaucoma medical, laser or surgical therapy.
43 eyes (43 patients) treated by residents were compared with 68 eyes (68 patients) treated by attendings with mean age of 70.3±11.8 and 69.5±11.8 years, respectively (p=0.742). Attending-treated eyes had a significantly higher proportion of primary SLT compared to resident-treated eyes (25.0% and 2.3%, respectively, p<0.001) and a smaller number of pre-operative glaucoma drops (1.6±1.3, 3.0±1.2, p<0.001) than the resident-treated eyes (Table 1). There were no significant differences between the 2 groups in percent IOP reduction from baseline at all time points after 3 months (p>0.05). 7.0% of resident-treated eyes and 13.2% of attending-treated eyes experienced an IOP spike (defined as IOP increase > 6 mmHg) within 1 hour of the procedure (p=0.315) (Table 2). There were no significant differences in the rate of additional glaucoma therapy required between attending-treated and resident-treated eyes (36.8%, 39.5%, respectively, p=0.779) and time to requiring additional therapy (14.6 ± 11.2, 14.5 ± 12.0 months, p=0.972). Attending-treated eyes received a significantly greater number of laser spots (128.3±29.7, 99.2±25.9, respectively, p<0.001), and a trend of higher total energy (108.7±29.6, 95.7±43.7, p=0.086) than resident-treated eyes.
SLT performed by residents at a Veterans Affairs facility had similar IOP outcomes when compared to SLT performed by attending physicians at a tertiary care center. Attending physicians tend to use SLT more as a primary treatment.
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