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Editors Selection IGR 19-4
Surgical Treatment: Trends in Glaucoma Surgery
Comment by Rupert Bourne on:
78029 Trends in Glaucoma Surgical Procedures in Portugal: A 16-Year Nationwide Study (2000-2015), Barbosa-Breda J; Gonçalves-Pinho M; Santos JV et al., Journal of Glaucoma, 2018; 27: 682-686
In this paper, Barbosa-Breda et al. report a retrospective database analysis of inpatient and surgical outpatients' episodes of all public hospitals in mainland Portugal, in order to model the change in types of glaucoma surgery conducted between 2000 and 2015. Although this does not reflect the full panorama of glaucoma surgery in the country, given that a quarter of all ophthalmic procedures are carried out in private facilities, this does give an interesting overview of practice patterns in a European country which can be compared with similar studies over different time periods in other countries. A previous study has shown that in 2015, 2.2% of the total Portuguese population were taking at least one ocular hypotensive eye drop medication, which gives context to this country's burden of known glaucoma/treated ocular hypertension.1 Other European and high-income countries such as the UK,2 the Netherlands,3 Canada4 and the USA5 noted a reduction in trabeculectomies in the mid-1990s to mid-2000s with the advent of prostaglandins. In several countries there followed a later upsurge, for example in the UK between 2005 and 2009.6
This does give an interesting overview of practice patterns in a European country which can be compared with similar studies over different time periods in other countriesThe authors note that the all-surgery glaucoma surgical rate is increasing as one would expect in an ageing population yet for trabeculectomies there was a relatively stable rate observed in Portugal (7/100,000) between 2000 and 2015. Interestingly, the average age of patients undergoing glaucoma surgery was approximately 67 years throughout this time period, suggesting that Portuguese ophthalmologists have been consistent in offering surgery relatively early in a patient's period of care. The authors comment that with older patients, ophthalmologists may favor augmenting topical treatment or offering laser on account of a shorter life expectancy and more in the way of comorbidities. Cyclophotoablation rates increased over the time period with a steep increase in 2015 (accounting for 16% of the glaucoma surgical procedures undertaken), possibly reflecting its use across a wider range of glaucoma severities than in the past.
References
- Sousa DC, Leal I, Nascimento N, et al. Use of ocular hypotensive medications in Portugal: PEM study: a cross-sectional nation-wide analysis. J Glaucoma. 2017;2:571-576.
- Keenan TDL, Wotton CJ, Goldacre MJ. Recent trends in the rate of trabeculectomy in England. Eye. 2011;25:1243-1245.
- van der Valk R, Schouten JS, Webers CA, Beckers HJ, van Amelsvoort LG, Schouten HJ et al. The impact of a nationwide introduction of new drugs and a treatment protocol for glaucoma on the number of glaucoma surgeries. J Glaucoma 2005;14(3):239-242.
- Rachmiel R, Trope GE, Chipman ML, Gouws P, Buys YM. Effect of medical therapy on glaucoma filtration surgery rates in Ontario. Arch Ophthalmol 2006;124(10):1472-1477.
- Strutton DR, Walt JG. Trends in glaucoma surgery before and after the introduction of new topical glaucoma pharmacotherapies. J Glaucoma 2004;13(3):221-226.
- Tatham A, Sarodia U. Trends in the rate of trabeculectomy. Eye (London, England). 2010;24:1532-1533.
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