Glaucoma surgery preferences when the surgeon adopts the role of the patient

Eye (Lond). 2019 Oct;33(10):1577-1583. doi: 10.1038/s41433-019-0452-9. Epub 2019 May 1.

Abstract

Background/objectives: To survey the members of the American Glaucoma Society (AGS) to determine which glaucoma procedures they would prefer to have performed on themselves.

Subjects/methods: We distributed an anonymous, electronic survey via the AGS listserv. The participants were asked to adopt the role of a patient with primary open angle glaucoma with progressive visual field loss in need of glaucoma surgery. Three preoperative intraocular pressure (IOP) levels were provided (>26 mmHg, 21-26 mmHg, and <21 mmHg), and the participants were asked to choose a glaucoma procedure they would prefer performed on themselves under each preoperative IOP levels from a list of fifteen procedures.

Results: Out of 289 responses (representing 27.4% of active and provisional AGS members), the most preferred procedures were ab interno trabeculotomy (20.3%), Xen gel stent (18.6%), iStent with two devices (14.3%) and traditional trabeculectomy augmented with mitomycin C (14.1%). 17.6% and 6.9% of participants preferred a trabeculectomy performed or a glaucoma drainage device (GDD) implanted on themselves, which is a lower than what would be offered to a hypothetical patient. Significant proportions of participants prefer non-bleb forming or conjunctiva-sparing procedures, even with low preoperative IOP levels. Older participants were more likely to prefer traditional trabeculectomy and having a single procedure across all levels of preoperative IOP.

Conclusions: The majority of AGS participants in the survey would prefer micro-invasive glaucoma surgery over traditional trabeculectomy or a GDD performed on themselves as a primary glaucoma procedure, and most would prefer non-bleb forming and conjunctiva-sparing procedures.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Glaucoma Drainage Implants*
  • Glaucoma, Open-Angle / physiopathology
  • Glaucoma, Open-Angle / surgery*
  • Health Care Surveys
  • Humans
  • Intraocular Pressure / physiology
  • Male
  • Middle Aged
  • Ophthalmologists / statistics & numerical data
  • Ophthalmology / organization & administration
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Role Playing
  • Societies, Medical / statistics & numerical data
  • Trabeculectomy*