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Editors Selection IGR 9-4

Surgical Treatment: Impact of anti-glaucoma therapy on surgery volume- and age-profile

Comment by Augusto Azuara Blanco on:

24151 The impact of available anti-glaucoma therapy on the volume and age profile of patients undergoing glaucoma filtration surgery, Keane PA; Khan MI; Saeed A et al., Eye, 2009; 23: 1675-1680

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Keane et al. (1209) reported a decrease in glaucoma surgery rates over a 20-year period in a relatively small hospital in South East Ireland in a cohort study. The descriptive statistical analysis was adequate. Two glaucoma surgeons were involved. This is an interesting topic that has attracted already a number of studies. Thus, there is lack of novelty in this report. One interesting finding was the similar age of patients undergoing glaucoma surgery over the two decades. The clinical decision to recommend glaucoma surgery is subjective and other factors (in addition to the availability of new glaucoma medications) may play a role. This issue may be relevant in a study involving only two surgeons. The authors briefly acknowledged this complex issue of what influences decision making.

We need to have more data on what happens to glaucoma patients with 'real-life care' after 10-20 years

I wonder whether the authors could have attempted to evaluate long-term outcomes of glaucoma care, and perhaps could have tried to compare patient care 20 years ago and recent care. How many patients go blind from glaucoma? We need to have more data on what happens to glaucoma patients with 'real-life care' after 10-20 years. Other interesting data that would have added interest to this report would be to evaluate the trends of health care cost (i.e., cost of medications, number of office visits, visual field testing..) over time. However, these tasks are difficult to accomplish retrospectively.

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