Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) in the US: IRIS Registry Analysis 2013-2018

Abstract

Purpose : Understanding trends and patterns in the use of minimally invasive glaucoma surgery (MIGS) as well as patient profiles undergoing each procedure is important given their relative expense and unknown long-term safety and effectiveness.

Methods : We used the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS®) Registry between 2013-2018 (inclusive) to measure adjusted annual number of MIGS and standard surgical techniques (trabeculectomy or glaucoma drainage device (GDD)) performed in the US, stratified by demographic characteristics. Secondary analyses of concurrent surgeries and of subsequent surgeries for MIGS and standard surgical technique were also conducted.

Results : 202,574 eyes and 232,537 unique procedures had associated, documented ICD 9/10 codes for glaucoma and were included in final analyses. Those receiving either iStent or endoscopic cyclophotocoagulation (ECP) were more likely to be female, while those receiving GDDs were more likely to be younger and male (p<0.05). Those receiving either iStent or Xen Gel stent were more likely to be White, while those receiving GDD, goniotomy or trabeculectomy were more likely to be Black (p<0.001). There was an increase in annual MIGS procedures over the study period (from 7,586 in 2013 to 39,677 in 2018), and a reciprocal decrease in standard glaucoma procedures (from 16,215 to 13,701). The proportion of iStent procedures tripled during the study period (from 14% to 40%), and by 2017 accounted for 43.7% of all glaucoma surgeries in the US. 21,524 (10.6%) of all eyes received multiple procedures; 7,381 (34.3%) on the same day and 14,143 (65.7%) on subsequent days. ECP and iStent were the most common concurrent procedures (58.9% of all concurrent procedures). Trabeculectomy and GDD were most commonly followed by another standard glaucoma surgery.

Conclusions : There was a significant increase in MIGS use over the recent six-year period despite limited evidence of their long-term safety or effectiveness, highlighting the need for studies comparing safety and outcomes of novel MIGS vs traditional surgical treatments for glaucoma.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure3. Number and distribution of glaucoma surgical procedures over Jan 2013 – Dec 2018 among patients with associated glaucoma diagnosis.