POAG Preferences

As the glaucoma landscape shifts, with more efficacious and safe treatments becoming more widely available to the general public, it seems reasonable that practitioner’s preferred methods will align with a wider range of options. To this end, the Journal of Glaucoma compiled a 33-question study to survey ophthalmologists’ first-line treatment choices for glaucoma, specifically primary open-angle glaucoma (POAG).

The survey was distributed across an American Society of Cataract and Refractive Surgery (ASCRS) database, and included questions on the practitioner’s country of practice, length of time in the field, glaucoma fellowship training details, and primary treatment preferences for POAG patients (e.g., topical medication versus laser trabeculoplasty or intracameral sustained release implants).

Of the 19,246 surveys sent to respondents in 2021, 252 (1.3 percent) were completed and returned. The study revealed that 73.6 percent of the respondents preferred to use topical medication for first-line POAG treatment, as opposed to 26.4 percent who preferred laser treatment as their starting point. “Given that the survey was performed in 2021, I was both heartened and a little surprised that 26 percent of respondents were already offering SLT [selective retina therapy] as first-line treatment,” says Douglas Rhee, the study’s lead author and Chair of the Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine.

The research team also observed that a majority of respondents from both sets preferred to use a trabecular meshwork bypass stent in cases where POAG was moderate and there was a visually significant cataract. Although they are not certain about why this method is preferred, the authors speculate that “it is likely reflective of a shift in preferred practice and community standards based on the relative safety and efficacy of this combined approach.”

The authors believe the study results highlight a continuing unmet need for education on evidence-based treatment results for POAG. It is “a snapshot of the community standard,” says Rhee. “For those offering SLT first, you can be reassured that you are not alone aside from being supported by a very high quality of science amassed over two decades.” Individual patient factors will determine what is best for an individual patient, Rhee adds, “but based on the clinical science and the available treatments in 2024, I believe that SLT first should be the new community standard.”