Practice Patterns and Technology Readiness for Sulcus Tube Placement: A Survey of the American Glaucoma Society Membership.

Purpose: To evaluate glaucoma surgeons' practice patterns regarding glaucoma drainage device (GDD) tube shunt placement, assess their opinions on sulcus tube placement, and evaluate their receptiveness to technologies designed to improve sulcus tube placement.

Patients and methods: A 12-question survey was distributed electronically to American Glaucoma Society (AGS) members between November 6 and December 23, 2024. The survey assessed surgeons' current tube-shunt placement practice patterns, factors influencing tube placement decisions, and receptiveness to proposed technologies designed for sulcus tube placement. Descriptive analysis was performed on 121 completed responses.

Results: Most respondents (55%) reported a preference for placing tubes in the anterior chamber (AC) for the majority of their pseudophakic patients, with efficiency (62%), safety (62%), and familiarity (57%) reported as primary factors for this decision. Barriers to sulcus placement included concern for intraocular bleeding (67%), technical difficulty of sulcus placement (54%), the risk of vitreous loss and tube occlusion (53%), and iris complications (53%). However, if a sulcus tube insertion technology was available and assuming a randomized controlled trial (RCT) demonstrated the superiority of sulcus over AC placement in minimizing endothelial cell loss (ECL), 85% of respondents indicated they would be likely to routinely place tubes in the sulcus. Features deemed very important for such a technology included tube placement accuracy (87%), ease of use (86%), IOP-lowering effectiveness (73%), time-efficiency (71%), and affordability (67%).

Conclusion: Currently, most glaucoma surgeons favor AC tube placement due to its familiarity, efficiency, and perceived safety, despite associated long-term risk of endothelial cell loss (ECL). Survey findings suggest strong interest in adopting sulcus placement, assuming a proven benefit on ECL and the availability of sulcus placement technologies designed to mitigate technical challenges. Development of robust data and reliable sulcus insertion technologies/techniques may change practice patterns.