Abstract
To analyze nationwide pre-operative gonioscopy utilization patterns for various glaucoma surgeries and laser surgeries over time using the IRIS
Registry (Intelligent Research in Sight).
Retrospective cohort study.
All adults who underwent a glaucoma surgery or laser surgery between January 1, 2014 and April 14, 2023.
The first glaucoma procedure from the first eye of each patient was recorded as the index event and time was measured between the most recent pre-operative gonioscopy date to the index event. Baseline demographics, pre-operative clinical characteristics, glaucoma diagnosis, procedure type, and type of subspecialist performing the procedure were collected.
Primary outcomes were the percentage of patients who had gonioscopy before a glaucoma procedure (1) at any prior visit and (2) within 1 year prior to the procedure. Secondary outcomes were the baseline factors that were associated with higher gonioscopy utilization at any prior visit using multivariable logistic regression.
The study included 1.1 million patients (mean age 69.5±12.0 years). A majority had an in-office laser surgery (71.9%), while 16.2% had microinvasive glaucoma surgeries (MIGS), 6.5% had a trabeculectomy or tube (traditional), and 4.6% had other glaucoma surgeries. Pre-operative gonioscopy was identified in 64.7% of patients, and 85.0% of those were within 1 year of the index event.In multivariable models, Asian (OR 1.16, 95%CI 1.13-1.18,
<0.001) and Black (OR 1.13, 95%CI 1.12-1.15,
<0.001) racial and ethnic groups were associated with higher odds of gonioscopy compared to White groups. When compared to traditional surgery, MIGS were associated with lower utilization (OR 0.69, 95%CI 0.68-0.71,
<0.001), but in-clinic laser surgeries were not (
=0.231). Glaucoma subspecialists were more likely to perform pre-operative gonioscopy compared to non-glaucoma subspecialists (OR 2.65, 95%CI 2.62-2.69,
<0.001).
Pre-operative gonioscopy use and/or coding is lower than expected, given current guidelines. Among glaucoma procedures, ab interno MIGS were associated with lower pre-operative gonioscopy utilization.