Patterns and Disparities in Recorded Gonioscopy During Initial Glaucoma Evaluations in the United States

Overview

Journal Am J Ophthalmol

Specialty Ophthalmology

Date 2024 Feb 29

PMID 38423202

Authors

Jun Hui Lee

Kristy Yoo

Khristina Lung

Galo Apolo

Brian Toy

Carina Sanvicente

Benjamin Xu

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess patterns in gonioscopy during initial glaucoma evaluations in the United States.

Design: Retrospective, case-control study.

Methods: Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural Terminology (CPT) codes.

Results: Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower (P < .001) among non-Hispanic Whites (OR=0.84) but similar for Blacks (OR=1.02) and Hispanics (OR=0.96) compared with Asians. Age ≥60 years (OR<0.82), pseudophakia/aphakia (OR=0.58), or residence outside of the Northeast region (OR=0.66-0.84) conferred lower odds of recorded gonioscopy (P < .001). Angle closure glaucoma (OR=0.85), secondary glaucoma (OR=0.31), or open angle glaucoma/suspect (OR=0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients (P < .01).

Conclusions: More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in non-Northeast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes.

Citing Articles

Factors Associated with Gonioscopy Before Glaucoma Procedures in the IRIS Registry.

Vu D, Gilbert J, Goldberg E, Rothman A, Lin M, Chang T Res Sq. 2025; .

PMID: 39877086 PMC: 11774446. DOI: 10.21203/rs.3.rs-5789587/v1.

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