Specialty: Ophthalmology

Keywords: Ophthalmology, Glaucoma, Minimally invasive glaucoma surgery, Incisional glaucoma surgery, Medicare

Background: Glaucoma, a leading cause of irreversible blindness, is primarily managed by reducing intraocular pressure (IOP), with primary open-angle glaucoma (OAG) being the most common form. Minimally invasive glaucoma surgery (MIGS) provides a safer alternative to traditional surgeries, but some patients still require incisional surgery due to disease progression or insufficient IOP control. The factors influencing the need for incisional surgery after MIGS remain poorly understood, especially in Medicare populations, and understanding these factors can optimize patient selection and treatment strategies.

Objective: Examine demographic, systemic, and ocular factors associated with incisional glaucoma surgery after MIGS in the 2019 California (CA) Medicare population.

Methods: This cross-sectional study used the 2019 Medicare Part-B claims database to identify CA beneficiaries aged 65+ with Part-A and Part-B coverage who had claims for open-angle glaucoma, cataract surgery, and MIGS. The primary outcome was at least one claim for incisional glaucoma surgery (trabeculectomy or tube shunt). Factors examined included demographics, Social Vulnerability Index (SVI), Charlson Comorbidity Index score, and glaucoma severity. Multivariable logistic regression modeling assessed associations with incisional surgery odds.

Results: Of 5,947 CA Medicare beneficiaries meeting inclusion criteria, 121 (2.03%) underwent incisional glaucoma surgery. Older age (≥80 years) was associated with lower odds of incisional surgery (aOR 0.65, 95% CI: 0.42–0.99). Moderate (aOR 4.66, 95% CI: 1.64–13.19), severe (aOR 22.08, 95% CI: 8.01–60.84), and unknown glaucoma severity (aOR 8.40, 95% CI: 2.81–25.09) were associated with increased odds of incisional surgery.

Conclusions: Among 2019 CA Medicare beneficiaries with MIGS, older age was associated with a decreased likelihood of incisional surgery, while advanced glaucoma was associated with an increased likelihood. These findings suggest that incisional surgery uptake depends more on clinical need than on social or demographic factors, although further studies are needed to explore disparities in glaucoma surgical selection.