Treatment Patterns of Childhood Glaucoma in the United States: Analysis of IRISⓇ Registry (Intelligent Research in Sight)

• Published in: American journal of ophthalmology Vol. 271; pp. 210 - 221
• Main Authors: Fujita, Asahi, Vu, Daniel M., Aziz, Kanza, Chang, Ta Chen, Chung, In Young, Ciociola, Elizabeth C., Friedman, David S., Lokhande, Anagha, Lorch, Alice C., Miller, Joan W., Parikh, Prashit, Rothman, Adam L., Seresirikachorn, Kasem, Elze, Tobias, Zebardast, Nazlee, Pershing, Suzann, Hyman, Leslie, Haller, Julia A., Lee, Aaron Y., Lee, Cecilia S., Lum, Flora, Lorch, Alice
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2025
• Subjects: Adolescent; Antihypertensive Agents - therapeutic use; Child; Child, Preschool; Female; Filtering Surgery - methods; Filtering Surgery - statistics & numerical data; Follow-Up Studies; Glaucoma - epidemiology; Glaucoma - physiopathology; Glaucoma - surgery; Glaucoma - therapy; Glaucoma Drainage Implants; Humans; Infant; Infant, Newborn; Intraocular Pressure - physiology; Male; Practice Patterns, Physicians' - statistics & numerical data; Registries; Retrospective Studies; Trabeculectomy; United States - epidemiology; United States
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.11.020

•One in 6 childhood glaucoma eyes underwent glaucoma-related procedures.•Nearly all received antiglaucoma medications.•The most common first-recorded procedure was angle surgery for primary congenital glaucoma, tube shunt surgery for glaucoma following cataract surgery and secondary glaucoma, and laser trabeculoplasty for juvenile open angle glaucoma.•Laser trabeculoplasty was mainly performed by non-glaucoma, nonpediatric ophthalmologists.•Type of glaucoma, baseline intraocular pressure, and type of treating subspecialist were predictors for incisional glaucoma surgery. To investigate treatment patterns of childhood glaucoma in the United States. Retrospective clinical cohort study. Patients under 18 years of age with a diagnosis code for glaucoma between January 1, 2013, and December 31, 2020, in the IRISⓇ Registry (Intelligent Research in Sight). Patient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery. The primary outcomes were the percentage of childhood glaucoma eyes that underwent glaucoma-related procedures and those receiving intraocular pressure (IOP)-lowering medications. Our secondary outcomes were hazard ratios (HRs) of demographic and clinical factors for undergoing incisional surgeries. A total of 5017 eyes of 3069 patients were included in this study. Based on billing codes, 208 eyes (4.1%) had primary congenital glaucoma (PCG), 1911 eyes (38.1%) had juvenile open-angle glaucoma (JOAG), 999 eyes (19.9%) had glaucoma following cataract surgery (GFCS), and 1646 (32.8%) had secondary glaucoma other than GFCS. Out of 5017 eyes with childhood glaucoma, 808 eyes (16.1%) underwent glaucoma-related procedures, and 4698 eyes (93.6%) received antiglaucoma medications. Angle surgery was the most common first-recorded procedure for PCG, and tube shunt surgery for GFCS and secondary glaucoma. Laser trabeculoplasty was mainly performed for JOAG by nonglaucoma subspecialists. Factors associated with higher likelihood of incisional surgeries were PCG (vs JOAG, HR 5.40, 95% confidence interval [CI] 1.55–18.84, P = .008), increase in IOP (HR 1.06 per mmHg, CI 1.05–1.08, P < .001), and index date at age <1 year (vs ages 11–15 years, HR 6.08, CI 1.51 – 24.44, P = .011). Being cared for by a nonglaucoma subspecialist was associated with a lower likelihood of undergoing incisional surgery (HR: 0.32 (95% CI: 0.23 – 0.44, P < .001). We found that 1 in 6 childhood glaucoma eyes underwent glaucoma-related procedures, and nearly all received antiglaucoma medications. The choice of first-recorded procedure differed across age and diagnosis. Type of glaucoma, baseline IOP, age, and type of treating subspecialist were predictors for undergoing incisional glaucoma surgery.