Treatment patterns of childhood glaucoma in the United States: Analysis of IRIS® Registry (Intelligent Research in Sight)

Asahi Fujita; Daniel M Vu; Kanza Aziz; Ta Chen Chang; In Young Chung; Elizabeth C Ciociola; David S Friedman; Anagha Lokhande; Alice C Lorch; Joan W Miller; Prashit Parikh; Adam L Rothman; Kasem Seresirikachorn; Tobias Elze; Nazlee Zebardast; Suzann Pershing; Leslie Hyman; Julia A Haller; Aaron Y Lee; Cecilia S Lee; Flora Lum; Joan W Miller; Alice Lorch; IRIS® Registry Analytic Center Consortium

doi:10.1016/j.ajo.2024.11.020

Treatment patterns of childhood glaucoma in the United States: Analysis of IRIS® Registry (Intelligent Research in Sight)

Am J Ophthalmol. 2024 Nov 29:S0002-9394(24)00550-6. doi: 10.1016/j.ajo.2024.11.020. Online ahead of print.

Authors

Asahi Fujita¹, Daniel M Vu², Kanza Aziz², Ta Chen Chang³, In Young Chung², Elizabeth C Ciociola⁴, David S Friedman², Anagha Lokhande⁵, Alice C Lorch², Joan W Miller², Prashit Parikh², Adam L Rothman³, Kasem Seresirikachorn⁶, Tobias Elze², Nazlee Zebardast⁷, Suzann Pershing⁸, Leslie Hyman⁹, Julia A Haller⁹, Aaron Y Lee¹⁰, Cecilia S Lee¹¹, Flora Lum¹², Joan W Miller², Alice Lorch²; IRIS® Registry Analytic Center Consortium

Affiliations

¹ Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Japan Society for the Promotion of Science.
² Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
³ Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
⁴ Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore MD, USA.
⁵ Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; The Warren Alpert Medical School, Brown University, Providence, RI, USA.
⁶ Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand.
⁷ Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address: Nazlee_Zebardast@meei.harvard.edu.
⁸ Stanford University, Palo Alto, CA, USA.
⁹ Wills Eye Hospital, Philadelphia, PA, USA.
¹⁰ eScience Institute, University of Washington, Seattle, WA, USA; Department of Ophthalmology, University of Washington, Seattle, WA, USA.
¹¹ Department of Ophthalmology, University of Washington, Seattle, WA, USA.
¹² American Academy of Ophthalmology, San Francisco, CA, USA.

PMID: 39617117
DOI: 10.1016/j.ajo.2024.11.020

Abstract

Purpose: To investigate treatment patterns of childhood glaucoma in the United States.

Design: Retrospective clinical cohort study SUBJECTS: Patients under 18 years of age with a diagnosis code for glaucoma between January 1, 2013, and December 31, 2020, in the IRIS® Registry (Intelligent Research in Sight).

Methods: Patient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery.

Main outcome measures: The primary outcomes were the percentage of childhood glaucoma eyes that underwent glaucoma-related procedures and those receiving intraocular pressure (IOP)-lowering medications. Our secondary outcomes were hazard ratios (HRs) of demographic and clinical factors for undergoing incisional surgeries.

Results: A total of 5017 eyes of 3069 patients were included in this study. Based on billing codes, 208 eyes (4.1%) had primary congenital glaucoma (PCG), 1911 eyes (38.1%) had juvenile open-angle glaucoma (JOAG), 999 eyes (19.9%) had glaucoma following cataract surgery (GFCS), and 1646 (32.8%) had secondary glaucoma other than GFCS. Out of 5017 eyes with childhood glaucoma, 808 eyes (16.1%) underwent glaucoma-related procedures, and 4698 eyes (93.6%) received antiglaucoma medications. Angle surgery was the most common first-recorded procedure for PCG, and tube shunt surgery for GFCS and secondary glaucoma. Laser trabeculoplasty was mainly performed for JOAG by non-glaucoma subspecialists. Factors associated with higher likelihood of incisional surgeries were PCG (vs. JOAG, HR 5.40, 95% confidence interval [CI] 1.55-18.84, p = 0.008), increase in IOP (HR 1.06 per mmHg, CI 1.05-1.08, p<0.001), and index date at age < one year (vs. ages 11-15 years, HR 6.08, CI 1.51 - 24.44, p = 0.011). Being cared for by a non-glaucoma subspecialist was associated with a lower likelihood of undergoing incisional surgery (HR: 0.32 (95%CI: 0.23 - 0.44, p<0.001).

Conclusions: We found that 1 in 6 childhood glaucoma eyes underwent glaucoma-related procedures, and nearly all received antiglaucoma medications. The choice of first-recorded procedure differed across age and diagnosis. Type of glaucoma, baseline IOP, age, and type of treating subspecialist were predictors for undergoing incisional glaucoma surgery.

Keywords: IRIS® Registry; United States; childhood glaucoma; patterns; treatment.