Young glaucoma specialist practice patterns: Why do you do what you do?

Background

Despite trabeculectomy having long been considered the gold standard surgery for treating severe or recalcitrant glaucoma, the popularity of this operation among glaucoma specialists has gradually declined in recent decades with a concurrent rise in alternative intraocular pressure (IOP)-lowering procedures being performed.

Purpose

This pilot study investigates how experiences of recently graduated glaucoma specialists during training might have influenced their choice to either perform trabeculectomy or favor alternative procedures in their current practice.

Methods

An anonymous questionnaire was distributed to American Glaucoma Society members who completed fellowship training between 2018 and 2022. Questionnaire items assessed respondents' experiences in residency and fellowship training as well as their current practice as attendings regarding four procedures: trabeculectomy, tube-shunt, XEN Gel Stent, and ab-interno angle procedures.

Results

Of 66 total respondents, 64 (93.9%) reported feeling somewhat or entirely comfortable performing trabeculectomy following training. However, 42 (63.6%) said they do not often perform trabeculectomy, whereas 13 (19.7%) reported that they do. Those who reported performing trabeculectomy often (N ​= ​13) were influenced by the surgery's high success rates (92.3%), preoperative (76.9%) and intraoperative (84.6%) processes, and low postoperative complications (61.5%). Those who reported not performing trabeculectomy often (N ​= ​42) were most discouraged by the postoperative process of trabeculectomy, as well as socioeconomic (66.7%) and sociocultural (52.4%) characteristics of their patients. Factors such as volume performed during training (47.6%), cost-effectiveness (19.0%), and reimbursement rates (19.0%) were not considerable contributors.

Conclusions

While most young glaucoma specialists in our study report being comfortable performing trabeculectomy, the majority stated that they do not often perform the procedure in practice. Low trabeculectomy surgical volume during training was not cited as a notable barrier, whereas patient factors and preference for alternative procedures, depending on the clinical scenario, appeared to drive this trend.