Glaucoma Surgery

About Glaucoma Surgery

Glaucoma is the second most common cause of irreversible blindness in the United States, after age-related macular degeneration. While visual loss from glaucoma cannot be reversed, adequate control of intraocular pressure (IOP) can halt or slow the progressive loss of vision.

Medications such as eye drops can help patients avoid the need for laser treatment or surgery, but these entail long-term cost and some potential for local and systemic side effects. Laser treatment for glaucoma is generally quick, safe, and convenient, but in many patients it has only a relatively small effect in reducing IOP and the effect may wear off over time. For some patients, surgery to control IOP, and prevent glaucoma progression, is the best option.

Glaucoma implants, trabeculectomies, and cyclophotocoagulation are the mainstays of glaucoma surgery. In addition, newer procedures being performed are iStent® trabecular micro-bypass goniotomy, and gonioscopy-assisted transluminal trabeculectomy (GATT). A couple of years ago, the Institute added hydrus and xen to the armamentarium.

Volume of All Glaucoma Surgeries

2016 - 2020

GATT = gonioscopy-assisted transluminal trabeculectomy

During 2020, the trend for fewer trabeculectomies continued. Cyclophotocoagulation and placement of i-stent devices decreased considerably in 2020 over the past two years, but the institute did fewer procedures overall in 2020 due to the COVID pandemic. The number of revisions of trabeculectomy and glaucoma implants remained the same. Results will be tracked going forward to assess trends in newer procedures or minimally invasive glaucoma surgery (MIGS).

Volume of Trabeculectomy and Glaucoma Implant Surgeries

2016 – 2020

In 2020, although overall numbers of procedures were lower, nearly three times as many glaucoma implant procedures (104) were done as trabeculectomies (36), an increasing trend since 2016.

Volume of Conventional Surgery vs. MIGS

2016 - 2020

The number of procedures utilizing minimally invasive glaucoma surgery (MIGS) has increased yearly since 2015. In 2020, this trend continued despite fewer procedures overall. Only 29% (140 ) of 478 procedures were done with conventional surgery as opposed to 71% done with MIGS (338).

MIGS Volume

2016 – 2020

CPC = cyclophotocoagulation, GATT = gonioscopy-assisted transluminal trabeculectomy