Glaucoma Implant Failure Risk Linked With Lifestyle, Demographics

Female patient having eye pressure measurement therapy at ophthalmologist during covid 19 pandemic
Young woman wearing medical protective mask when having eye pressure measured at ophthalmologist
Procedure history, smoking status, laterality, ethnicity, and sex all influence the success of the implants, according to a study.

Risk for glaucoma drainage device (GDD) failure is associated with procedure history, smoking status, laterality, ethnicity, and sex, according to results of a study published in the American Journal of Ophthalmology.

Investigators from Harvard Medical School performed a literature review to evaluate potential risk factors for GDD failure. Potential risk factors for failure were evaluated among patients (N=44,330) who had a GDD inserted between 2013 and 2018. Data for this study were sourced from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry. GDD failure was defined as revision or device removal.

Potential GDD failure risk factors included age, gender, comorbidities, smoking status, and laterality.

The study population was 53.29% men, GDD was inserted at an average age of 65.42±14.16 years, 55.50% were White, 29.59% had primary open-angle glaucoma (POAG), 2.74% had comorbid dry eye disease, and 5.10% had a prior eye procedure.

Among those with device failure (7.57%), the average time to revision or removal was 293.82±373.45 days.

Risk for GDD failure was associated with chronic angle closure glaucoma (hazard ratio [HR], 1.32; P <.001) and comorbid dry eye disease (HR, 1.30; P =.007). An inverse relationship with failure risk was observed for unknown ethnicity (HR, 0.68; P <.001) and unknown race (HR, 0.83; P =.004).

In the final model, GDD failure was associated with past eye procedure (β, 104.83; P <.001), unknown ethnicity (β, -55.28; P =.013), active smoking status (β, 38.15; P =.024), right laterality (β, -38.67; P =.026), and male sex (β, -25.96; P =.044).

This study was limited by the high amount of missing data in the IRIS Registry, for example 74.80% of patients had unknown glaucoma severity, 47.24% had unknown laterality, and 12.17% had unknown ethnicity.

This study identified potential risk factors for GDD failure using a large database.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Hall NE, Chang EK, Samuel S, et al. Risk factors for glaucoma drainage device revision or removal using the IRIS Registry. Am J Ophthalmol. Published online April 2, 2022. doi:10.1016/j.ajo.2022.03.029