Open-Angle Glaucoma Treatment Preferences of US Glaucoma Specialists.

Prcis: This cross-sectional survey study evaluated the current treatment preferences of US glaucoma specialists for open-angle glaucoma, finding that most preferred selective laser trabeculoplasty over topical medications for treatment-naïve patients with ocular hypertension and open-angle glaucoma.

Purpose: To describe US glaucoma specialists' preferences regarding the use of selective laser trabeculoplasty (SLT) versus topical glaucoma medications for the treatment of open-angle glaucoma.

Methods: Actively practicing glaucoma specialists from the American Glaucoma Society were invited to participate in a survey assessing treatment preferences and influencing factors. Multivariable logistic regressions were performed to determine predictors of preference for SLT.

Results: Of 136 eligible respondents, 65-71% preferred SLT for treatment-naïve patients with ocular hypertension, mild-to-moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma, or pigmentary glaucoma. For mild-to-moderate POAG on one medication, 75% of respondents favored SLT. For advanced POAG on maximum medical therapy, 57% of respondents favored surgery and 38% preferred SLT. Respondents indicated that reducing medication non-adherence (93%), suitable glaucoma type or stage (88%), and experience performing SLT (83%) were key facilitators in recommending SLT to their patients. In contrast, patients' inability to position for the procedure (78%), unsuitable glaucoma type or stage (67%), and comorbidities or contraindications to SLT (55%) were primary reasons to not recommend SLT. Physicians in private practice, those who completed fellowship training more recently, and those who see more treatment-naïve glaucoma patients were significantly more likely to prefer SLT over medication.

Conclusion: The majority of US glaucoma specialists report a preference for SLT over medication for open-angle glaucoma treatment, demonstrating that acceptance of SLT has increased over the past several years, especially for treatment-naïve patients. Statistically significant predictors of SLT preference were practice setting, practice duration, and patient volume.