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Arthi Venkat, Rishi P Singh, Jonathan Eisengart, Ming Hu, Justis Ehlers, Amy Babiuch; Neovascular Glaucoma Management: Practice Patterns of Glaucoma and Retina Specialists in the United States. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3668.
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Neovascular glaucoma (NVG) arises from neovascularization of the anterior chamber angle, usually secondary to ischemic processes. Optimal management of NVG often requires combinations of therapies and collaboration between glaucoma and retina specialists, and no consensus exists regarding best practice management. The purpose of this survey study was to identify similarities and differences in NVG management between glaucoma and retina specialists.
An 8-question survey was opened for 6 weeks in 2016. Survey questions were developed with the intention of determining therapeutic preferences amongst retina and glaucoma specialists, and included initial therapy and next best-step clinical vignettes based on actual cases of NVG. The survey (administered using Survey Monkey™) was posted on the American Glaucoma Society (AGS) Listserv to 1200 members, and on the American Society of Retina Specialists (ASRS) Listserv to 1676 members.
109 glaucoma specialists and 130 retina specialists initiated the survey, with a completion rate of 81.6%. The response rate per question ranged from 195 to 235. For initial treatment of patients presenting with NVG, good vision (VA) and previous panretinal photocoagulation (PRP), retina specialists preferred anti-VEGF therapy alone (P<0.01) while glaucoma specialists opted for anti-VEGF combined with tube shunt surgery (P<0.01). The initial approach to patients with poor VA and NVG revealed no bias for PRP or anti-VEGF between the two groups, but a preference for glaucoma surgery by glaucoma specialists (24%) as compared to retina specialists (9%) was noted (P<0.01) in this setting. Next steps in NVG management were dependent on PRP status; in the presence of PRP there was no significant difference between groups for continued anti-VEGF therapy or tube shunt surgery. In PRP-naive eyes, 94% of retina specialists chose to perform PRP as compared to 68% of glaucoma specialists; glaucoma specialists also preferred tube shunt surgery in this setting (29%) versus 6% of retina specialists (P<0.01).
Similarities and differences were identified in practice patterns between retina and glaucoma specialists in managing patients with NVG. Further position papers might have both groups return for a consensus Delphi panel in addressing NVG for optimization of patient care.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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