Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.06.002
Helena Gali MD , Wendy W. Liu MD, PhD
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Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.03.011
Erin A. Boese MD , Wallace L.M. Alward MD , John H. Fingert MD, PhD
Objective
Mutations within the myocilin (MYOC) gene are the first known single-gene cause of both primary open-angle glaucoma and juvenile open-angle glaucoma (JOAG). Subsequent studies have shown these mutations cause trabecular meshwork dysfunction, resulting in markedly elevated intraocular pressures (IOPs) at young ages. Angle-based procedures, like gonioscopy-assisted transluminal trabeculotomy (GATT), bypass the trabecular meshwork, and as such, are hypothesized to be particularly effective in this angle-based disease. The purpose of this case series is to evaluate the efficacy of GATT for MYOC-associated JOAG.
Design
A retrospective chart review was performed evaluating patients under the age of 18 years with known MYOC-associated JOAG who underwent GATT. A total of 8 eyes of 4 children are included.
Participants
All participants had a strong family history of MYOC glaucoma.
Methods
All patients underwent a thorough clinical evaluation, including visual acuity, slit lamp examination, optic nerve fundoscopy, and IOP measurements by Goldmann applanation. Most patients also underwent 24-2 Swedish Interactive Thresholding algorithm (SITA) standard Humphrey visual fields and fundus photography, and all patients had retinal nerve fiber layer OCT.
Main Outcome Measures
Main outcome measures include IOP and number of medications. Additional measures include visual acuity, optic nerve photos, visual field testing, and OCT.
Results
Following 360° GATT, all 8 eyes of 4 children had a mean drop in IOP of 26 mmHg (68%), and all were able to stop glaucoma medications entirely. Our patients were followed up between 2.2 and 4.1 years with no evidence of decreasing efficacy or glaucomatous progression. All patients maintain 20/20 visual acuity or better in both eyes, and glaucoma has stabilized on all available ancillary testing (OCT, Humphrey visual field, and optic nerve photos). One patient (patient 4) had a notable reversal of cupping.
Conclusions
In MYOC-associated JOAG, the pathology is concentrated at the trabecular meshwork (TM), lending itself well to angle-based surgeries, especially GATT. Gonioscopy-assisted transluminal trabeculotomy is particularly effective in children with MYOC JOAG, allowing them to avoid, or at least delay, the need for more invasive surgeries like trabeculectomy and tube shunt surgeries with over 4 years of follow-up. To date, this is the first genetically directed glaucoma surgery available.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and
{"title":"Gonioscopy-Assisted Transluminal Trabeculotomy for Myocilin-Associated Juvenile Open-Angle Glaucoma","authors":"Erin A. Boese MD , Wallace L.M. Alward MD , John H. Fingert MD, PhD","doi":"10.1016/j.ogla.2025.03.011","DOIUrl":"10.1016/j.ogla.2025.03.011","url":null,"abstract":"<div><h3>Objective</h3><div><span>Mutations within the myocilin (</span><em>MYOC</em><span><span>) gene are the first known single-gene cause of both primary open-angle glaucoma and juvenile open-angle glaucoma (JOAG). Subsequent studies have shown these mutations cause trabecular meshwork dysfunction, resulting in markedly elevated </span>intraocular pressures<span> (IOPs) at young ages. Angle-based procedures, like gonioscopy-assisted transluminal trabeculotomy<span> (GATT), bypass the trabecular meshwork, and as such, are hypothesized to be particularly effective in this angle-based disease. The purpose of this case series is to evaluate the efficacy of GATT for </span></span></span><em>MYOC</em>-associated JOAG.</div></div><div><h3>Design</h3><div>A retrospective chart review was performed evaluating patients under the age of 18 years with known <em>MYOC</em>-associated JOAG who underwent GATT. A total of 8 eyes of 4 children are included.</div></div><div><h3>Participants</h3><div>All participants had a strong family history of <em>MYOC</em> glaucoma.</div></div><div><h3>Methods</h3><div><span><span>All patients underwent a thorough clinical evaluation<span>, including visual acuity, </span></span>slit lamp examination<span>, optic nerve fundoscopy, and IOP measurements by Goldmann applanation. Most patients also underwent 24-2 Swedish Interactive Thresholding algorithm (SITA) standard Humphrey visual fields and </span></span>fundus photography<span><span>, and all patients had retinal nerve fiber layer </span>OCT.</span></div></div><div><h3>Main Outcome Measures</h3><div>Main outcome measures include IOP and number of medications. Additional measures include visual acuity, optic nerve photos, visual field testing, and OCT.</div></div><div><h3>Results</h3><div>Following 360° GATT, all 8 eyes of 4 children had a mean drop in IOP of 26 mmHg (68%), and all were able to stop glaucoma medications entirely. Our patients were followed up between 2.2 and 4.1 years with no evidence of decreasing efficacy or glaucomatous progression. All patients maintain 20/20 visual acuity or better in both eyes, and glaucoma has stabilized on all available ancillary testing (OCT, Humphrey visual field, and optic nerve photos). One patient (patient 4) had a notable reversal of cupping.</div></div><div><h3>Conclusions</h3><div>In <em>MYOC-</em>associated JOAG, the pathology is concentrated at the trabecular meshwork (TM), lending itself well to angle-based surgeries, especially GATT. Gonioscopy-assisted transluminal trabeculotomy is particularly effective in children with <em>MYOC</em><span> JOAG, allowing them to avoid, or at least delay, the need for more invasive surgeries like trabeculectomy<span> and tube shunt surgeries with over 4 years of follow-up. To date, this is the first genetically directed glaucoma surgery available.</span></span></div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and ","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 466-473"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.04.004
Alessandro Ghirardi MD , Siqi Fan MD , Karl Mercieca MD, FRCOphth , Gianni Virgili MD , Stefano De Cillà MD , Alessandro Rabiolo MD
<div><h3>Topic</h3><div>Compare different methods to deliver mitomycin<span> C (MMC) in trabeculectomy surgery.</span></div></div><div><h3>Clinical Relevance</h3><div>Knowing the best way to apply MMC may provide guidance to glaucoma surgeons and improve outcomes.</div></div><div><h3>Methods</h3><div><span>Systematic review<span> and meta-analysis (PROSPERO CRD42023394371) for studies comparing ≥ 2 methods to apply MMC in trabeculectomy published until February 22, 2023, from Medline, EMBASE, and CENTRAL. Randomized clinical trials (RCTs), quasi-randomized, and prospective nonrandomized controlled studies published in English and conducted on human subjects were included. The primary outcome was surgical failure at 1 year. Secondary outcomes included </span></span>intraocular pressure<span> (IOP), number of glaucoma medications<span>, postoperative complications, and interventions. A random-effects meta-analysis was conducted for ≥ 3 studies, whereas a fixed-effect model was used for 2 studies. The certainty of evidence was assessed with Grading Recommendations Assessment, Development and Evaluation (GRADE) score.</span></span></div></div><div><h3>Results</h3><div>From 7899 records, 8 articles from 7 RCTs compared intraoperative sub-Tenon MMC injection (315 participants) and intraoperative MMC-soaked sponges (327 participants). One RCT and 1 quasi-randomized study compared postoperative (60 participants) and intraoperative (60 participants) MMC-soaked sponge application. In the injection vs. sponges comparison, no significant difference in surgical failure (relative risk [RR]: 0.78, 95% confidence interval [CI]: 0.48–1.28; <em>P</em> = 0.33, GRADE score moderate) or IOP (mean difference [MD]: −0.85 mmHg, 95% CI: −2.19 to 0.49; <em>P</em> = 0.21, GRADE score moderate) was found at 1 year. Sub-Tenon injection resulted in fewer postoperative medications (MD: −0.40, 95% CI: −0.63 to −0.18; <em>P</em> < 0.001; GRADE score moderate) and better bleb morphology (GRADE score high) in terms of height (MD: −0.39, 95% CI: −0.61 to −0.18; <em>P</em> < 0.001), extension (MD: 0.28, 95% CI: 0.11–0.45; <em>P</em><span> = 0.001), and vascularity (MD: −0.52, 95% CI: −0.72, −0.31; </span><em>P</em> < 0.001) than sponges. Serious complication and reintervention rates were low and comparable between groups. We did not perform a meta-analysis comparing postoperative and intraoperative sponge application because of heterogeneity in the study designs of the included studies.</div></div><div><h3>Conclusions</h3><div>Intraoperative sub-Tenon MMC injection is noninferior to intraoperative MMC-soaked sponges in trabeculectomy surgery in terms of surgical failure and IOP control, with a reduced number of medications, improved bleb morphology, and similar safety profile. Further research with a long-term follow-up is necessary to confirm their long-term equivalence.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found
{"title":"Comparison of Methods to Deliver Mitomycin C in Trabeculectomy Surgery","authors":"Alessandro Ghirardi MD , Siqi Fan MD , Karl Mercieca MD, FRCOphth , Gianni Virgili MD , Stefano De Cillà MD , Alessandro Rabiolo MD","doi":"10.1016/j.ogla.2025.04.004","DOIUrl":"10.1016/j.ogla.2025.04.004","url":null,"abstract":"<div><h3>Topic</h3><div>Compare different methods to deliver mitomycin<span> C (MMC) in trabeculectomy surgery.</span></div></div><div><h3>Clinical Relevance</h3><div>Knowing the best way to apply MMC may provide guidance to glaucoma surgeons and improve outcomes.</div></div><div><h3>Methods</h3><div><span>Systematic review<span> and meta-analysis (PROSPERO CRD42023394371) for studies comparing ≥ 2 methods to apply MMC in trabeculectomy published until February 22, 2023, from Medline, EMBASE, and CENTRAL. Randomized clinical trials (RCTs), quasi-randomized, and prospective nonrandomized controlled studies published in English and conducted on human subjects were included. The primary outcome was surgical failure at 1 year. Secondary outcomes included </span></span>intraocular pressure<span> (IOP), number of glaucoma medications<span>, postoperative complications, and interventions. A random-effects meta-analysis was conducted for ≥ 3 studies, whereas a fixed-effect model was used for 2 studies. The certainty of evidence was assessed with Grading Recommendations Assessment, Development and Evaluation (GRADE) score.</span></span></div></div><div><h3>Results</h3><div>From 7899 records, 8 articles from 7 RCTs compared intraoperative sub-Tenon MMC injection (315 participants) and intraoperative MMC-soaked sponges (327 participants). One RCT and 1 quasi-randomized study compared postoperative (60 participants) and intraoperative (60 participants) MMC-soaked sponge application. In the injection vs. sponges comparison, no significant difference in surgical failure (relative risk [RR]: 0.78, 95% confidence interval [CI]: 0.48–1.28; <em>P</em> = 0.33, GRADE score moderate) or IOP (mean difference [MD]: −0.85 mmHg, 95% CI: −2.19 to 0.49; <em>P</em> = 0.21, GRADE score moderate) was found at 1 year. Sub-Tenon injection resulted in fewer postoperative medications (MD: −0.40, 95% CI: −0.63 to −0.18; <em>P</em> < 0.001; GRADE score moderate) and better bleb morphology (GRADE score high) in terms of height (MD: −0.39, 95% CI: −0.61 to −0.18; <em>P</em> < 0.001), extension (MD: 0.28, 95% CI: 0.11–0.45; <em>P</em><span> = 0.001), and vascularity (MD: −0.52, 95% CI: −0.72, −0.31; </span><em>P</em> < 0.001) than sponges. Serious complication and reintervention rates were low and comparable between groups. We did not perform a meta-analysis comparing postoperative and intraoperative sponge application because of heterogeneity in the study designs of the included studies.</div></div><div><h3>Conclusions</h3><div>Intraoperative sub-Tenon MMC injection is noninferior to intraoperative MMC-soaked sponges in trabeculectomy surgery in terms of surgical failure and IOP control, with a reduced number of medications, improved bleb morphology, and similar safety profile. Further research with a long-term follow-up is necessary to confirm their long-term equivalence.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found ","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 503-514"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.06.009
Steven J. Gedde MD , Leon W. Herndon Jr. MD
The surgical options for managing glaucoma have expanded exponentially in recent years. Traditional glaucoma surgery includes trabeculectomy and tube shunt surgery. These procedures drain aqueous into the subconjunctival space, and they are highly effective at lowering intraocular pressure (IOP). Laser suture lysis and releasable sutures allow the surgeon to selectively increase outflow after trabeculectomy, and the ability to titrate IOP postoperatively is an advantage of trabeculectomy over other glaucoma procedures. Mitomycin C and 5-fluorouracil are adjunctive antifibrotic agents that have been shown to improve the success of trabeculectomy, but they also increase the risk of complications such as hypotony maculopathy and bleb-related infections. Tube shunts have been used with increasing frequency as an alternative to trabeculectomy. A silicone tube maintains the patency of the drainage fistula and shunts aqueous humor to an end plate. Devices with larger end plates produce greater IOP reduction, and the presence of a flow restrictor in valved implants serves to reduce the risk of hypotony-related complications. Minimally invasive glaucoma surgery (MIGS) is a newer group of nonbleb-forming procedures performed via an ab interno approach and involves minimal disruption of ocular tissues. Trabecular meshwork/Schlemm’s canal MIGS improve aqueous drainage through the conventional outflow system by stenting, dilating, or cutting/stripping the trabecular meshwork and inner wall of Schlemm’s canal. Suprachoroidal MIGS create a cyclodialysis and increase uveoscleral flow through a device that connects the anterior chamber and suprachoroidal space. The various MIGS procedures are frequently performed in combination with phacoemulsification in patients with mild to moderate open-angle glaucoma. Minimally invasive glaucoma surgery offers a more favorable safety profile than traditional glaucoma surgery, but MIGS are less effective in lowering IOP. A trade-off exists between safety and efficacy with all currently available glaucoma operations. Surgical innovation in glaucoma has provided surgeons with the opportunity to tailor the selection of a procedure to the individual patient. Multicenter randomized clinical trials have provided valuable information to guide the surgical care of glaucoma patients.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Glaucoma Surgery","authors":"Steven J. Gedde MD , Leon W. Herndon Jr. MD","doi":"10.1016/j.ogla.2025.06.009","DOIUrl":"10.1016/j.ogla.2025.06.009","url":null,"abstract":"<div><div>The surgical options for managing glaucoma have expanded exponentially in recent years. Traditional glaucoma surgery includes trabeculectomy and tube shunt surgery. These procedures drain aqueous into the subconjunctival space, and they are highly effective at lowering intraocular pressure (IOP). Laser suture lysis and releasable sutures allow the surgeon to selectively increase outflow after trabeculectomy, and the ability to titrate IOP postoperatively is an advantage of trabeculectomy over other glaucoma procedures. Mitomycin C and 5-fluorouracil are adjunctive antifibrotic agents that have been shown to improve the success of trabeculectomy, but they also increase the risk of complications such as hypotony maculopathy and bleb-related infections. Tube shunts have been used with increasing frequency as an alternative to trabeculectomy. A silicone tube maintains the patency of the drainage fistula and shunts aqueous humor to an end plate. Devices with larger end plates produce greater IOP reduction, and the presence of a flow restrictor in valved implants serves to reduce the risk of hypotony-related complications. Minimally invasive glaucoma surgery (MIGS) is a newer group of nonbleb-forming procedures performed via an ab interno approach and involves minimal disruption of ocular tissues. Trabecular meshwork/Schlemm’s canal MIGS improve aqueous drainage through the conventional outflow system by stenting, dilating, or cutting/stripping the trabecular meshwork and inner wall of Schlemm’s canal. Suprachoroidal MIGS create a cyclodialysis and increase uveoscleral flow through a device that connects the anterior chamber and suprachoroidal space. The various MIGS procedures are frequently performed in combination with phacoemulsification in patients with mild to moderate open-angle glaucoma. Minimally invasive glaucoma surgery offers a more favorable safety profile than traditional glaucoma surgery, but MIGS are less effective in lowering IOP. A trade-off exists between safety and efficacy with all currently available glaucoma operations. Surgical innovation in glaucoma has provided surgeons with the opportunity to tailor the selection of a procedure to the individual patient. Multicenter randomized clinical trials have provided valuable information to guide the surgical care of glaucoma patients.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages S49-S57"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.04.011
Javier García-Bardera MD , Julian Garcia-Feijoo MD, PhD , Laura Morales-Fernández MD, PhD , Clara Heredia-Pastor MD , Álvaro Ponce-de-León MD , Mireia García-Bermúdez MD , Marco Antonio Pascual-Santiago MD , Bárbara Burgos-Blasco MD, PhD , Jose María Martínez-de-la-Casa MD, PhD , Julián Garcia-Sánchez MD, PhD
Purpose
To evaluate the clinical outcomes of Preserflo MicroShunt (PMS) implantation with mitomycin C (MMC) in managing refractory childhood glaucoma previously treated with Ahmed glaucoma valve (AGV).
Design
A single-arm retrospective cohort study.
Participants
Twenty-three eyes of 22 patients with refractory childhood glaucoma and a history of AGV implantation.
Methods
All patients underwent PMS implantation with intraoperative MMC (0.04% for 2.5 minutes). Primary endpoints included intraocular pressure (IOP) reduction, reduction in antiglaucomatous medications, and surgical success. “Complete success” was defined as achieving target IOP without medications; “qualified success” allowed for medications. Safety parameters included intraoperative and postoperative complications and the need for further interventions.
Main Outcome Measures
Intraocular pressure reduction, antiglaucomatous medication reduction, and surgical success rates.
Results
Median follow-up was 23 months (interquartile range: 18–41). Mean baseline IOP was 27.0 ± 4.3 mmHg with 3.2 ± 0.5 medications. At 1 year, IOP decreased to 14.1 ± 4.4 mmHg (−47.0%) with 0.4 ± 1.0 medications and to 16.9 ± 3.6 mmHg (−40.2%) with 1.2 ± 1.5 medications at 2 years. Overall success rates for ≥20% IOP reduction were 91.3% at 1 year (69.9% complete success) and 72.7% at 2 years (45.5% complete success); for ≥30% reduction, they were 82.6% and 63.6%, respectively. During follow-up, 1 case of device extrusion was observed at 3 months, and another required surgical revision at 5 months.
Conclusions
Preserflo MicroShunt implantation with MMC offers a valuable surgical option for managing refractory childhood glaucoma after AGV. The procedure achieved substantial reductions in both IOP and medication burden. Larger studies with extended follow-up are recommended to confirm its long-term efficacy.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Outcomes of Preserflo MicroShunt Implantation in Refractory Childhood Glaucoma Following Ahmed Glaucoma Valve Surgery","authors":"Javier García-Bardera MD , Julian Garcia-Feijoo MD, PhD , Laura Morales-Fernández MD, PhD , Clara Heredia-Pastor MD , Álvaro Ponce-de-León MD , Mireia García-Bermúdez MD , Marco Antonio Pascual-Santiago MD , Bárbara Burgos-Blasco MD, PhD , Jose María Martínez-de-la-Casa MD, PhD , Julián Garcia-Sánchez MD, PhD","doi":"10.1016/j.ogla.2025.04.011","DOIUrl":"10.1016/j.ogla.2025.04.011","url":null,"abstract":"<div><h3>Purpose</h3><div><span>To evaluate the clinical outcomes of Preserflo MicroShunt (PMS) implantation with mitomycin C (MMC) in managing refractory </span>childhood glaucoma<span> previously treated with Ahmed glaucoma valve (AGV).</span></div></div><div><h3>Design</h3><div>A single-arm retrospective cohort study.</div></div><div><h3>Participants</h3><div>Twenty-three eyes of 22 patients with refractory childhood glaucoma and a history of AGV implantation.</div></div><div><h3>Methods</h3><div>All patients underwent PMS implantation with intraoperative MMC (0.04% for 2.5 minutes). Primary endpoints included intraocular pressure<span> (IOP) reduction, reduction in antiglaucomatous medications, and surgical success. “Complete success” was defined as achieving target IOP without medications; “qualified success” allowed for medications. Safety parameters included intraoperative and postoperative complications and the need for further interventions.</span></div></div><div><h3>Main Outcome Measures</h3><div>Intraocular pressure reduction, antiglaucomatous medication reduction, and surgical success rates.</div></div><div><h3>Results</h3><div>Median follow-up was 23 months (interquartile range: 18–41). Mean baseline IOP was 27.0 ± 4.3 mmHg with 3.2 ± 0.5 medications. At 1 year, IOP decreased to 14.1 ± 4.4 mmHg (−47.0%) with 0.4 ± 1.0 medications and to 16.9 ± 3.6 mmHg (−40.2%) with 1.2 ± 1.5 medications at 2 years. Overall success rates for ≥20% IOP reduction were 91.3% at 1 year (69.9% complete success) and 72.7% at 2 years (45.5% complete success); for ≥30% reduction, they were 82.6% and 63.6%, respectively. During follow-up, 1 case of device extrusion was observed at 3 months, and another required surgical revision at 5 months.</div></div><div><h3>Conclusions</h3><div>Preserflo MicroShunt implantation with MMC offers a valuable surgical option for managing refractory childhood glaucoma after AGV. The procedure achieved substantial reductions in both IOP and medication burden. Larger studies with extended follow-up are recommended to confirm its long-term efficacy.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 495-502"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.03.012
Jason Dossantos BS, Hoang-Viet Tran BS, Sinan Akosman BA, Julie Thomasian MD, David Belyea MD, MBA
<div><h3>Purpose</h3><div>To examine how the coronavirus disease 2019 (COVID-19) pandemic impacted the relationship between Medicare reimbursement and glaucoma procedure service volume in the United States.</div></div><div><h3>Design</h3><div>A retrospective, longitudinal database study.</div></div><div><h3>Participants</h3><div>A complete dataset of all glaucoma procedures performed on Medicare Part B beneficiaries from 2019 to 2022.</div></div><div><h3>Methods</h3><div>Linear mixed-effects model using Medicare Part B data, controlling for year, charges, denials, reimbursement-to-charge ratio (RCR), service setting, Current Procedural Terminology code, state, Medicare population, number of ophthalmologists, and median income. The RCR was calculated as the ratio of weighted mean reimbursement to weighted mean charge, representing the proportion of reimbursed charges. Weighted averages for denials, charges, and reimbursements (adjusted for inflation) were also calculated.</div></div><div><h3>Main Outcome Measures</h3><div>Payment-volume elasticities, defined as the percent change in procedure volume per 1% change in Medicare payment, for traditional glaucoma surgeries (tubes and shunts), minimally invasive glaucoma surgeries (MIGSs), and laser procedures. Additional measures included weighted averages of charges, reimbursements, denials, and RCR across procedure categories and service settings.</div></div><div><h3>Results</h3><div>Traditional surgeries showed a 2.3% decrease in volume per 1% payment increase (95% confidence interval [CI]: −2.9% to −1.7%; <em>P</em> < 0.001; Rc<sup>2</sup> = 0.89) and a 10.2% decline in volume. Mean reimbursement for traditional surgeries decreased by 5%, with a 7.7% drop in RCR. Laser procedures exhibited a 6.7% volume decrease per 1% payment increase (95% CI: −7.1% to −6.2%; <em>P</em> < 0.001; Rc<sup>2</sup> = 0.97) and a 16% total decline, with no change in RCR. Minimally invasive glaucoma surgeries declined by 16.2% overall but demonstrated an 8.3% volume increase per 1% payment rise (95% CI: 7.9%–8.7%; <em>P</em> < 0.001; Rc<sup>2</sup> = 0.90), with a 64% improvement in RCR. Overall, glaucoma procedure volumes fell by 15.6%, mean reimbursement decreased by 7.3%, and denied claims increased by 46.7%. Ambulatory surgical centers (ASCs) experienced a 15.2% volume decline but an 11.5% increase in reimbursement, supported by a 42.9% rise in RCR.</div></div><div><h3>Conclusions</h3><div>Glaucoma procedure volumes declined between 2019 and 2022, particularly for traditional surgeries and MIGS. Traditional and laser procedures had negative payment-volume elasticities, whereas MIGS showed positive elasticity. These findings suggest factors beyond reimbursement rates, like shifts to less invasive treatments and COVID-19 disruptions, significantly influenced clinical decision-making.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disc
{"title":"Impact of the COVID-19 Pandemic on Medicare Reimbursement and Glaucoma Procedure Utilization","authors":"Jason Dossantos BS, Hoang-Viet Tran BS, Sinan Akosman BA, Julie Thomasian MD, David Belyea MD, MBA","doi":"10.1016/j.ogla.2025.03.012","DOIUrl":"10.1016/j.ogla.2025.03.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine how the coronavirus disease 2019 (COVID-19) pandemic impacted the relationship between Medicare reimbursement and glaucoma procedure service volume in the United States.</div></div><div><h3>Design</h3><div>A retrospective, longitudinal database study.</div></div><div><h3>Participants</h3><div>A complete dataset of all glaucoma procedures performed on Medicare Part B beneficiaries from 2019 to 2022.</div></div><div><h3>Methods</h3><div>Linear mixed-effects model using Medicare Part B data, controlling for year, charges, denials, reimbursement-to-charge ratio (RCR), service setting, Current Procedural Terminology code, state, Medicare population, number of ophthalmologists, and median income. The RCR was calculated as the ratio of weighted mean reimbursement to weighted mean charge, representing the proportion of reimbursed charges. Weighted averages for denials, charges, and reimbursements (adjusted for inflation) were also calculated.</div></div><div><h3>Main Outcome Measures</h3><div>Payment-volume elasticities, defined as the percent change in procedure volume per 1% change in Medicare payment, for traditional glaucoma surgeries (tubes and shunts), minimally invasive glaucoma surgeries (MIGSs), and laser procedures. Additional measures included weighted averages of charges, reimbursements, denials, and RCR across procedure categories and service settings.</div></div><div><h3>Results</h3><div>Traditional surgeries showed a 2.3% decrease in volume per 1% payment increase (95% confidence interval [CI]: −2.9% to −1.7%; <em>P</em> < 0.001; Rc<sup>2</sup> = 0.89) and a 10.2% decline in volume. Mean reimbursement for traditional surgeries decreased by 5%, with a 7.7% drop in RCR. Laser procedures exhibited a 6.7% volume decrease per 1% payment increase (95% CI: −7.1% to −6.2%; <em>P</em> < 0.001; Rc<sup>2</sup> = 0.97) and a 16% total decline, with no change in RCR. Minimally invasive glaucoma surgeries declined by 16.2% overall but demonstrated an 8.3% volume increase per 1% payment rise (95% CI: 7.9%–8.7%; <em>P</em> < 0.001; Rc<sup>2</sup> = 0.90), with a 64% improvement in RCR. Overall, glaucoma procedure volumes fell by 15.6%, mean reimbursement decreased by 7.3%, and denied claims increased by 46.7%. Ambulatory surgical centers (ASCs) experienced a 15.2% volume decline but an 11.5% increase in reimbursement, supported by a 42.9% rise in RCR.</div></div><div><h3>Conclusions</h3><div>Glaucoma procedure volumes declined between 2019 and 2022, particularly for traditional surgeries and MIGS. Traditional and laser procedures had negative payment-volume elasticities, whereas MIGS showed positive elasticity. These findings suggest factors beyond reimbursement rates, like shifts to less invasive treatments and COVID-19 disruptions, significantly influenced clinical decision-making.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disc","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages 474-483"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.06.010
Tony Realini MD, MPH , Gus Gazzard MD
The rapid and extensive expansion of therapeutic options for glaucoma management provides both the opportunity and the resources necessary to broadly reconsider our 150+ year topical medications-first approach. Although topical medications are safe and efficacious, their effectiveness is limited by less-than-ideal adherence. The reasons why patients do not take their medications as prescribed have been extensively studied and are both complex—having many facets—and complicated—having no simple solution. Novel therapies, including sustained-release medication platforms, selective laser trabeculoplasty (SLT), and minimally invasive glaucoma surgery, present opportunities to bypass topical medications and absolve patients of the responsibility for self-dosing of topical therapy. Because poor adherence increases the risk of glaucoma progression, moving away from topical therapy offers the potential for better long-term outcomes. In this article, we will review the strengths and limitations of topical medical therapy and propose that—based on new and emerging data—the paradigm shift to primary SLT is both entirely appropriate for the vast majority of patients and long overdue. We will also describe our conversations with patients about SLT, with the goal of facilitating readers’ integration of primary SLT into their clinical practices.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Selective Laser Trabeculoplasty and the Evolving Glaucoma Paradigm","authors":"Tony Realini MD, MPH , Gus Gazzard MD","doi":"10.1016/j.ogla.2025.06.010","DOIUrl":"10.1016/j.ogla.2025.06.010","url":null,"abstract":"<div><div>The rapid and extensive expansion of therapeutic options for glaucoma management provides both the opportunity and the resources necessary to broadly reconsider our 150+ year topical medications-first approach. Although topical medications are safe and efficacious, their effectiveness is limited by less-than-ideal adherence. The reasons why patients do not take their medications as prescribed have been extensively studied and are both complex—having many facets—and complicated—having no simple solution. Novel therapies, including sustained-release medication platforms, selective laser trabeculoplasty (SLT), and minimally invasive glaucoma surgery, present opportunities to bypass topical medications and absolve patients of the responsibility for self-dosing of topical therapy. Because poor adherence increases the risk of glaucoma progression, moving away from topical therapy offers the potential for better long-term outcomes. In this article, we will review the strengths and limitations of topical medical therapy and propose that—based on new and emerging data—the paradigm shift to primary SLT is both entirely appropriate for the vast majority of patients and long overdue. We will also describe our conversations with patients about SLT, with the goal of facilitating readers’ integration of primary SLT into their clinical practices.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages S38-S44"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ogla.2025.07.009
Janey L. Wiggs MD, PhD , Louis R. Pasquale MD
Genetic analyses have led to the identification of 12 genes primarily responsible for early-onset glaucoma and hundreds of genomic loci influencing adult-onset disease risk. Childhood glaucoma genes encode for proteins involved in ocular development and extracellular matrix, while genetic factors influencing adult-onset disease are involved in a number of biological pathways and processes. Genes responsible for glaucoma and genetic factors influencing disease risk can be used for genetic testing, allowing for informed genetic counseling for early-onset glaucoma cases and families and risk stratification using PRS for adult-onset disease. Genetic testing for glaucoma can identify people with high disease risk and allow for surveillance and timely treatment that can prevent permanent loss of vision. Current studies suggest that glaucoma genetic architecture is complex, especially in adult-onset disease, involving multiple genetic and/or environmental risk factors. Priorities for future work include the discovery of novel genes and genetic causality, as well as functional studies to define molecular mechanisms underlying disease pathophysiology.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Glaucoma Genetics: Lessons Learned and the New Frontier","authors":"Janey L. Wiggs MD, PhD , Louis R. Pasquale MD","doi":"10.1016/j.ogla.2025.07.009","DOIUrl":"10.1016/j.ogla.2025.07.009","url":null,"abstract":"<div><div>Genetic analyses have led to the identification of 12 genes primarily responsible for early-onset glaucoma and hundreds of genomic loci influencing adult-onset disease risk. Childhood glaucoma genes encode for proteins involved in ocular development and extracellular matrix, while genetic factors influencing adult-onset disease are involved in a number of biological pathways and processes. Genes responsible for glaucoma and genetic factors influencing disease risk can be used for genetic testing, allowing for informed genetic counseling for early-onset glaucoma cases and families and risk stratification using PRS for adult-onset disease. Genetic testing for glaucoma can identify people with high disease risk and allow for surveillance and timely treatment that can prevent permanent loss of vision. Current studies suggest that glaucoma genetic architecture is complex, especially in adult-onset disease, involving multiple genetic and/or environmental risk factors. Priorities for future work include the discovery of novel genes and genetic causality, as well as functional studies to define molecular mechanisms underlying disease pathophysiology.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 5","pages":"Pages S27-S32"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ogla.2025.02.003
Takashi Nishida MD, PhD , Vincent Q. Pham BS , Sasan Moghimi MD , Christopher A. Girkin MD, MSPH , Massimo A. Fazio PhD , Jeffrey M. Liebmann MD , Linda M. Zangwill PhD , Robert N. Weinreb MD
Purpose
To investigate the association between optic disc size and circumpapillary retinal nerve fiber layer (cpRNFL) thinning in eyes with preperimetric glaucoma and glaucoma.
Design
Observational cohort.
Participants
A total of 841 eyes (554 primary open angle glaucoma and 287 preperimetric glaucoma) from 553 patients who had at least 4 visits and 2 years of follow-up using OCT.
Methods
Multivariable linear mixed-effects modeling was used to estimate the effect of optic disc size on cpRNFL thinning while controlling for covariates. To eliminate the floor effect, eyes with baseline visual field mean deviation less than −14 dB were excluded.
Main Outcome Measures
The effect of optic disc size on cpRNFL thinning.
Results
Of the participants, 189 (34.2%) were Black, 338 (61.1%) were White, 20 (3.6%) were Asian, and 6 (1.1%) were another race or ethnicity. Mean follow-up period was 5.3 (95% confidence interval [CI], 5.2–5.5) years, and the mean rate of cpRNFL change was −0.54 (95% CI, −0.61 to 0.47) μm/year. After adjusting for covariates with the Littmann’s formula correction, larger optic disc size was associated with faster cpRNFL thinning (−0.03; 95% CI, −0.05 to 0.00) μm/year faster per 0.1 mm2 larger; P = 0.034), while no significant differences were found for race and its interaction with optic disc size.
Conclusions
Larger optic disc size is associated with faster cpRNFL thinning in glaucoma, independent of race. Although previous studies have indicated that Black individuals may be at higher risk for glaucoma development, the present study suggests that race may not be a significant predictor of faster cpRNFL thinning when controlling for optic disc size and other clinical and demographic factors in glaucoma.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Optic Disc Size and Circumpapillary Retinal Nerve Fiber Layer Thinning in Glaucoma","authors":"Takashi Nishida MD, PhD , Vincent Q. Pham BS , Sasan Moghimi MD , Christopher A. Girkin MD, MSPH , Massimo A. Fazio PhD , Jeffrey M. Liebmann MD , Linda M. Zangwill PhD , Robert N. Weinreb MD","doi":"10.1016/j.ogla.2025.02.003","DOIUrl":"10.1016/j.ogla.2025.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the association between optic disc size and circumpapillary retinal nerve fiber layer (cpRNFL) thinning in eyes with preperimetric glaucoma and glaucoma.</div></div><div><h3>Design</h3><div>Observational cohort.</div></div><div><h3>Participants</h3><div>A total of 841 eyes (554 primary open angle glaucoma and 287 preperimetric glaucoma) from 553 patients who had at least 4 visits and 2 years of follow-up using OCT.</div></div><div><h3>Methods</h3><div>Multivariable linear mixed-effects modeling was used to estimate the effect of optic disc size on cpRNFL thinning while controlling for covariates. To eliminate the floor effect, eyes with baseline visual field mean deviation less than −14 dB were excluded.</div></div><div><h3>Main Outcome Measures</h3><div>The effect of optic disc size on cpRNFL thinning.</div></div><div><h3>Results</h3><div>Of the participants, 189 (34.2%) were Black, 338 (61.1%) were White, 20 (3.6%) were Asian, and 6 (1.1%) were another race or ethnicity. Mean follow-up period was 5.3 (95% confidence interval [CI], 5.2–5.5) years, and the mean rate of cpRNFL change was −0.54 (95% CI, −0.61 to 0.47) μm/year. After adjusting for covariates with the Littmann’s formula correction, larger optic disc size was associated with faster cpRNFL thinning (−0.03; 95% CI, −0.05 to 0.00) μm/year faster per 0.1 mm<sup>2</sup> larger; <em>P</em> = 0.034), while no significant differences were found for race and its interaction with optic disc size.</div></div><div><h3>Conclusions</h3><div>Larger optic disc size is associated with faster cpRNFL thinning in glaucoma, independent of race. Although previous studies have indicated that Black individuals may be at higher risk for glaucoma development, the present study suggests that race may not be a significant predictor of faster cpRNFL thinning when controlling for optic disc size and other clinical and demographic factors in glaucoma.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 4","pages":"Pages 343-350"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ogla.2024.12.002
Paula Anne Newman-Casey MD, Douglas J. Rhee MD, Alan L. Robin MD, Steven L. Mansberger MD, MPH
{"title":"Patient Challenges with Glaucoma Eye Drops: A Need to Identify Nonadherence and Facilitate Appropriate Support and Disease Management","authors":"Paula Anne Newman-Casey MD, Douglas J. Rhee MD, Alan L. Robin MD, Steven L. Mansberger MD, MPH","doi":"10.1016/j.ogla.2024.12.002","DOIUrl":"10.1016/j.ogla.2024.12.002","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 4","pages":"Pages 327-330"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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