Laser trabeculoplasty (LTP) did not significantly reduce the need for patients with mild open angle glaucoma (OAG) or OAG suspects to undergo incisional glaucoma surgery, researchers found in a study published in Ophthalmology Glaucoma.
LTP, a common treatment for ocular hypertension and OAG, has been shown to lower intraocular pressure (IOP), possibly reducing the need for glaucoma eye drops and glaucoma surgery. This investigation adds to the limited research on LTP’s effects on the risk for incisional glaucoma surgery.
The research included a 5% random sample of Medicare beneficiaries at least 35 years of age between 2012 and 2016 who had ICD-9 codes of ocular hypertension, preglaucoma, mild stage glaucoma, OAG with borderline findings, and unspecified OAG. They compared the 2435 eyes of 1567 patients who received LTP between 2012 and 2014 with those who had not received LTP or glaucoma incisional surgery for a year. The patients were matched on age, gender, race, geographic region, glaucoma diagnosis, and history of cataract surgery. They had at least 2 years of consecutive follow-up.
Forty eyes (1.6%) in the LTP group and 51 eyes (2.1%) in the comparison group required glaucoma surgery within 2 years (P =.24). There was no statistically significant difference between the groups in risk of progression to glaucoma or risk of glaucoma surgery before or after controlling for demographic factors and diagnosis codes.
Black patients were almost twice as likely to require glaucoma surgery compared with White patients after adjusting for LTP and other demographics. Black patients were more than 3 times as likely to either require glaucoma surgery or experience glaucoma progression compared with White patients after controlling for treatment with LTP. Patients with a diagnosis of OAG were more likely to require glaucoma surgery compared with those who were only glaucoma suspects.
In a sensitivity analysis of patients with ocular hypertension and borderline OAG, cumulative incidence of glaucoma surgery was 2.3% among Black patients and .08% among White patients, without adjusting for follow-up time. Black patients had higher glaucoma surgical burden and disease progression (P <.0001).
“Patients who receive LTP still require routine monitoring and appropriate escalation of treatment,” report the investigators.
Limitations of the study included dependence upon the accuracy of ICD-9 and Current Procedural Terminology (CPT) coding in Medicare claims datasets, accuracy of self-reported race, and lack of data on IOPs and medication use.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Lee RH, Lee RK, Pasquale LR. Burden of trabeculectomy and glaucoma drainage implantation following laser trabeculoplasty: a two-year follow up study. Ophthalmol Glaucoma. Published online July 18, 2021. doi:10.1016/j.ogla.2021.07.004