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

Asahi Fujita Daniel M Vu Kanza Aziz Ta Chen Chang In Young Chung Elizabeth C Ciociola David S Friedman Anagha Lokhande Alice C Lorch Joan W Miller Prashit Parikh Adam L Rothman Kasem Seresirikachorn Tobias Elze Nazlee Zebardast

Am J Ophthalmol

From the Department of Ophthalmology (A.F., D.M.V., K.A., I.Y.C., D.S.F., A.L., A.C.L., J.W.M., P.P., K.S., T.E., N.Z., J.W.M., A.L.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Published: November 2024

The study aimed to analyze treatment patterns for childhood glaucoma in the U.S. by examining patient records from 2013 to 2020.
It included 3069 patients, revealing that only 16.1% underwent surgery while 93.6% were treated with medications, with specific procedures varying based on the type of glaucoma.
Key factors influencing the need for surgeries included having primary congenital glaucoma, higher intraocular pressure, and being younger than one year at diagnosis.

Purpose: To investigate treatment patterns of childhood glaucoma in the United States.

Design: Retrospective clinical cohort study.

Subjects: 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).

Methods: Patient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery.

Main Outcome Measures: 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.

Results: 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).

Conclusions: 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.

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http://dx.doi.org/10.1016/j.ajo.2024.11.020	DOI Listing

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