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Yvonne M Buys, Andrei-Alexandru Szigiato, Graham Eric Trope, Yaping Jin; Trends in Glaucoma Surgical Procedures in Ontario: 1992- 2012. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2659.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze trends in the surgical management of glaucoma in Ontario over the last two decades and compare these to published trends elsewhere.
Ontario Health Insurance Plan billing service claims between 1992 and 2012 were analyzed for the yearly number of glaucoma laser and incisional surgical procedures. Data for combined procedures was only available from 2000. The yearly number of Ontarians with primary open-angle glaucoma (POAG) was estimated by applying composite prevalence curves to published population data and the yearly number of procedures per 1000 Ontarians with POAG was calculated.
Per 1000 people with POAG, laser trabeculoplasty rates (LT) increased nearly 2 fold (185%) from 138 in 1992 to 255 in 2012, with the rates stabilizing between 2008-2012. LT rates increased 8% from 1992-1996, decreased 52% from 1996-2001, and increased 288% from 2001-2008. Total glaucoma filtration procedure (GFP) rates (trabeculectomy, glaucoma drainage device (GDD) and combined GFP and cataract extraction) per 1000 people with POAG in 2012 were similar to those in 1992 (33.5 vs 34.6, respectively), with a peak rate in 1996. GFP rates increased 37.7% from 1992-1996, decreased 32% from 1996-2010 and increased 10.5% from 2010-12. From 2000-12 the rates of trabeculectomy alone remained unchanged, the number of GDD alone increased over 5 fold, combined trabeculectomy and cataract extraction decreased 81% while combined GDD and cataract extraction increased from 6 in 2000 to 420 in 2012. GDD represented 0.9% of the GFP performed in 1992 increasing to 33% in 2012. Combined GDD and cataract extraction represented 0.4% of combined cataract extractions in 2000 and 26.3% in 2012.
Over the past two decades there was an overall increase in the rate of LT, no change in the rate of trabeculectomies and an increase in GDD which in 2012 accounted for 1/3rd of GFP. These changes coincide with the introduction of SLT and MIGS. Decreases in the rate of combined cataract trabeculectomy can be attributed to replacement by combined cataract and GDD. In 2012, almost 1 in 5 GFP were repeat surgeries. Comparable rates in GFP over a similar period were also seen in the UK, Australia, and the Netherlands. Only one US study showed comparable rates of LT, but none have shown an unchanged rate from 2009 onwards.
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