Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 28:14:2551-2560.
doi: 10.2147/OPTH.S257361. eCollection 2020.

GlaucoMap - Distribution of Glaucoma Surgical Procedures in the United States

Anthony K Ma  1 , Jun Hui Lee  1 , Joshua L Warren  2 , Christopher C Teng  3
Affiliations

GlaucoMap - Distribution of Glaucoma Surgical Procedures in the United States

Anthony K Ma et al. Clin Ophthalmol. .

Abstract

Purpose: To understand the distribution of trabeculectomies, glaucoma drainage implants (GDI) and micro-invasive glaucoma surgeries (MIGS) performed in the United States through geospatial mapping.

Methods: We performed an observational cohort study to evaluate glaucoma surgeries in patients age ≥65. The most recently released data from Centers for Medicare Part B Carrier Summary Files were queried to determine the number of glaucoma surgeries performed per state during the year of 2017. We created choropleth maps, titled "GlaucoMap", to characterize the rates of various surgeries performed across the United States, defined as the number of procedures performed per 10,000 individuals. A chi-squared analysis was further used to evaluate differences in surgical preferences across geographic region. Standardized residuals (SR) were calculated to determine regional influences on surgical distribution.

Results: There were 174,788 glaucoma surgeries performed: 22,862 trabeculectomies (13.1%), 19,991 GDI (11.4%) and 131,935 (75.5%) MIGS. The Northeast had the highest trabeculectomy rate, GDI was highest in the Southeast and MIGS were highest in the Southwest. There was a statistically significant difference in proportional use of conventional surgeries versus MIGS across various regions in the United States (p < 0.0001). Given the high trabeculectomy and GDI rates and relatively low MIGS adoption in the Southeast, we observed a +7.03 SR for conventional surgeries and -4.01 SR for MIGS. The Southwest and Western states had the highest MIGS rate and contributed +3.29 and +3.24 SR toward disproportional MIGS preference, respectively. The preference for conventional surgeries in the Northeast (SR = +2.93) and MIGS in the Midwest (SR = +0.99) also contribute to the overall differences in glaucoma surgeries across the United States.

Conclusion: GlaucoMap is useful for visualizing the distribution of glaucoma surgeries in the United States. The heterogeneity in surgical preferences points to regional differences in glaucoma management.

Keywords: GDI; MIGS; glaucoma; heatmaps; trabeculectomies.

PubMed Disclaimer

Conflict of interest statement

Christopher Teng reports consulting fees from Neomedix and New World Medical, outside the submitted work. The authors have no other potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
National distribution of (A) trabeculectomies (B) glaucoma drainage implants (C) MIGS (D) and total glaucoma surgeries across the United States in 2017. Color bars indicate the number of procedures performed per 10,000 individuals in a particular state.
Figure 2
Figure 2
(A) Regional and (B) statewide preference for trabeculectomy vs GDI vs MIGS in glaucoma management. Columns indicate the percentage of surgeries performed per region for each procedure type.
Figure 3
Figure 3
Regional variations in preference for MIGS when choosing a surgical procedure for glaucoma. Color bar indicates the number of MIGS divided by the total number of glaucoma procedures performed per state. Red indicates low MIGS preference while blue indicates high MIGS preference.
See this image and copyright information in PMC

References

    1. Kingman S. Glaucoma is second leading cause of blindness globally. Bull World Health Organ. 2004;82(11):887–888. doi:/S0042-96862004001100019 - PMC - PubMed
    1. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081–2090. doi:10.1016/j.ophtha.2014.05.013 - DOI - PubMed
    1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90(3):262–267. doi:10.1136/bjo.2005.081224 - DOI - PMC - PubMed
    1. Sharaawy T, Bhartiya S. Surgical management of glaucoma: evolving paradigms. Indian J Ophthalmol. 2011;59(Suppl):S123–30. doi:10.4103/0301-4738.73692 - DOI - PMC - PubMed
    1. Khan M, Saheb H, Neelakantan A, et al. Efficacy and safety of combined cataract surgery with 2 trabecular micro bypass stents versus ab intern trabeculotomy. J Cataract Refract Surg. 2015;41(8):1716–1724. doi:10.1016/j.jcrs.2014.12.061 - DOI - PubMed