Abstract
Purpose :
In the present study, we performed a population-based data mining analysis to gain a deeper understanding of risk factors for the failure of laser trabeculoplasty through innovations in Big Data science.
Methods :
The University of Missouri Health Care system is one of the largest health networks in Missouri. Patient clinical data can be accessed via the i2b2 data portal. Data collection was acquired from glaucoma-related diagnostic and procedure codes from the years 2010-2018. Of the glaucoma patients analyzed, these patients were then sub-categorized into patients who had undergone laser trabeculoplasty failure, which for the purposes of this study, was defined as patients who were forced to undergo another treatment of laser trabeculoplasty or further surgical glaucoma intervention due to inadequate IOP control within the study time period. Demographic information including race, gender, age, and smoking status was included for analysis. Other potential risk factors such as blepharitis, diabetes mellitus, hypertension, presence of crystalline or artificial lens, aphakia, uveitis, previous ocular trauma, and dry eye syndrome were also included for the purposes of this study.
Results :
We analyzed a total of 13,240 glaucoma patients. 282 out of 1119 laser trabeculoplasty patients were found to have undergone procedure failure. Odds ratio analysis showed that systemic hypertension, alcohol use, and< age 60 were risk factors for statistically significant increased rates of laser treatment failure (p -value < 0.05). In this study, females appeared to have a statistically significant increase in glaucoma laser failure over males. Furthermore smoking, aphakia, and uveitis all appear to be associated with laser failure (P<0.01).
Conclusions :
This study successfully elucidates the role that demographic and diagnostic data analyzed in a Big Data fashion can help to identify different risk factors for laser trabeculoplasty failure on a massive scale. Similar to what occurs in other tissues in the body, we surmise that smoking may induce fibrosis via inflammatory cytokines and free radicals in the trabecular meshwork and the canal of Schlemm. Our results suggest that by emphasizing smoking cessation to patients undergoing laser trabecuoplasty, these patients may reap both overall health benefits as well as long term IOP control without the need for further procedures.
This is a 2020 ARVO Annual Meeting abstract.