In the US, the use of traditional procedures is reduced.

Despite the rapidly ageing population in the United States, as in the rest of the developed world, there has been a reduction in surgical procedures for the treatment of glaucoma. This interesting trend has been documented in a study by the Wilmer Eye Institute and Johns Hopkins University in Baltimore, now being published in Ophthalmology.
The retrospective study covers the period 1994-2012 and is based on data provided by Medicare on reimbursed procedures.
Overall, canaloplasty, mini-shunt implantation with an external approach, aqueous shunt implantation from the suprachoroidal space and endoscopic cyclophotocoagulation have increased significantly, while the use of conventional trabeculectomy and trans-scleral cyclophotocoagulation has decreased significantly.
Laser trabeculoplasty peaked in 2005, but has been less and less used since then (-19%). The number of laser iridotomies was also consistent in the period 2004-2012.
Overall, the use of surgery in cases of glaucoma was reduced by approximately 16% and, specifically, the use of surgical procedures other than laser, fell by as much as 31%.
It will be interesting to investigate how the results of this study can be related to the spread and effectiveness of medical therapies for glaucoma. Furthermore, as a trend towards a reduction in the use of trabeculectomy is confirmed, appropriate clinical trials will have to be set up to compare alternative procedures to the surgical therapy that has long been the gold standard of glaucoma surgery.

 For more details see theJuly Ophthalmology article.

Dr. Carmelo Chines
Direttore responsabile