Trends in Glaucoma Fellowship Surgical Experience.

Purpose: To evaluate trends in fellow exposure to trabeculectomy, tube shunt, and minimally invasive glaucoma surgery (MIGS) procedures during glaucoma fellowship training.

Methods: We analyzed fellowship surgical logs from 2013 to 2024 from the Association of University Professors of Ophthalmology (AUPO) Fellowship Compliance Committee to determine the frequency of trabeculectomy, tube shunt, and MIGS procedures within glaucoma fellowship programs.

Results: Our analysis revealed a 55.9% decrease with significant correlative decline (r = -0.89, p = 0.0002) over the 11-year study period in total trabeculectomy exposure (primary and assistant surgeon), while total tube shunt surgeries underwent a modest 7.3% decrease with significant correlative decline (r = -0.80, p = 0.003) over the 11-year study period, and MIGS procedures showed a marked 128.6% increase with significant correlative increase (r = +0.72, p = 0.02) from 2016 to 2024.

Conclusion: The declining exposure to trabeculectomy surgery, both as primary and assistant surgeon raises concerns about glaucoma fellowship graduate proficiency with this fundamental procedure. This may limit access to qualified care for specific glaucoma populations that may benefit most from this intervention, and for the continued care of patients that have previously undergone trabeculectomy surgery. These findings highlight the need to maintain proficiency in trabeculectomy to ensure optimal care for diverse glaucoma patient populations.