Abstract
Purpose :
The IRIS registry was used to examine how utilization of MIGS differs by glaucoma diagnosis and ocular characteristics/severity of disease. Minimally invasive glaucoma surgery (MIGS) is increasingly being performed in the US to treat glaucoma. At the time of MIGS introduction, use focused on eyes with mild to moderate glaucoma undergoing cataract surgery.
Methods :
Patients aged ≥40 years with a diagnosis of glaucoma, surgically naive, and undergoing cataract surgery between 1/1/2013 and 12/31/17 were included in this retrospective cohort study (N=410,238; N=43,833 eyes with MIGS). The current analysis looked at diagnosis, severity of disease, intraocular pressure (IOP), cup-to-disc ratio (CDR) and number of baseline medications. Eyes missing these variables were excluded. Descriptive statistics and odds ratios (OR) estimated with multivariable logistic regression were used to describe the association of these variables with having MIGS.
Results :
Glaucomatous eyes having cataract surgery with MIGS increased from 4.94% in 2013 to 15.67% in 2017. The glaucoma diagnoses in the MIGS group: primary open angle glaucoma (POAG) N=31,995 (73.0%), glaucoma suspect N=6220 (14.2%), pseudoexfoliation (PXF) + pigmentary glaucoma (PG) N=1624 (3.7%). In the non-MIGS group: POAG N=119,747(32.7%), glaucoma suspect N=224,013 (80.4%), PXF + PG N=7960 (2.2%). Currently, visual field and OCT resuls are not available so we relied on data from ICD-10 severity codes to stratify disease. Statistically significant differences in having MIGS was greater for CDR 0.5-0.8 than < 0.5 (OR=1.31) and for CDR 0.8-1.0 than < 0.5 (OR=1.42). 25% of the cohort had data on severity based on ICD-10 visual field criteria. In this subgroup (N=100,240), moderate glaucoma was slightly less likely (OR=0.91) and severe glaucoma much less likely (OR=0.51) to receive a MIGS procedure than those with mild glaucoma. The MIGS eyes used statistically significantly more medications at baseline than no MIGS (1.64 vs 0.79), had a higher baseline IOP (17.12 mmHg vs 16.78 mmHg) and a higher CDR (0.62 vs 0.53).
Conclusions :
This real-world analysis of patients allows us to discern small but significant differences in the utilization of MIGS by diagnosis, severity of disease and ocular characteristics. Long-term evaluation is needed to determine whether outcomes with MIGS procedures differ by these characteristics to better inform clinical care for glaucoma patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.