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

• Published in: Advances in ophthalmology practice and research Vol. 5; no. 4; pp. 227 - 234
• Main Authors: Miranda, Nicole, Zhang, Jason Y., Qiu, Mary
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2025; Elsevier
• Subjects: Current practice patterns; Glaucoma; Ophthalmology; Survey study; Trabeculectomy; Training experience; Glaucoma; Trabeculectomy; Current practice patterns; Training experience; Survey study
• ISSN: 2667-3762; 2667-3762
• DOI: 10.1016/j.aopr.2025.07.001

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. 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. 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. 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. 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.