Trends in neovascular glaucoma management: Practice patterns of glaucoma and retina specialists in the United States

Abstract

Purpose: To characterize practice patterns between and within retina and glaucoma subspecialists treating neo- vascular glaucoma (NVG). Methods: Preliminary survey study consisting of 8-questions developed based on actual clinical cases presenting to our institution between June 2014 and June 2016. The survey was administered in the form of clinical vignettes and circulated electronically using Survey Monkey ©. to members of the American Glaucoma Society (AGS) and American Society of Retina Specialists (ASRS). Results: 109 glaucoma and 130 retina specialists initiated the survey. For initial management of patients with good visual acuity (VA) and NVG, retina specialists preferred anti-VEGF therapy (P < 0.01) while glaucoma specialists preferred combined anti-VEGF and tube shunt surgery (P < 0.01). Following initial therapy in patients with good VA, glaucoma specialists preferred surgery (P < 0.01) and retina specialists preferred PRP (P < 0.01). In patients with poor VA, PRP and anti-VEGF were equally favored, with a preference for surgery by glaucoma specialists compared to retina specialists (P < 0.01). Conclusion: NVG is a complex problem within the field of ophthalmology that often requires management by both retina and glaucoma specialists. Agreement between both subspecialties for the use of anti-VEGF agents as first line treatment, either alone or in concert with other therapies was noted. Multiple differences exist in next step in therapy and long-term management. Future consensus panels may mitigate discrepancies in NVG management and work toward development of care paths for more efficient care delivery.