Subsequent Receipt of Interventions for Glaucoma Among a Nationwide Sample of Patients Who Underwent Laser Peripheral Iridotomy.

Abstract

To evaluate use of medical, laser, or incisional surgical interventions for glaucoma after laser peripheral iridotomy (LPI). Retrospective longitudinal cohort study. All enrollees aged ≥21 years in a US managed-care network who underwent bilateral LPIs in 2001-2011 were identified. The mean numbers of pre- and post-LPI glaucoma medication classes prescribed and the proportion of enrollees requiring cataract or glaucoma surgery within 2 years after the LPIs were determined. Multivariable logistic regression assessed factors associated with enrollees' prescription of ≥1 glaucoma medication class after bilateral LPIs. Of the 1660 patients undergoing bilateral LPIs, 1280 (77.1%) had no pre- or post-LPI prescriptions for any glaucoma medication class. Of the remaining patients, 251 (66.1%) required more glaucoma medication classes after than before the procedures, whereas 44 (11.6%) used fewer after the procedures; 85 (22.4%) were prescribed the same number before and after the LPIs. A total of 167 patients (10.1%) underwent cataract surgery and 79 (4.8%) received glaucoma surgery over the 2-year follow-up. Black patients had a 130% increased odds for glaucoma medication-class prescriptions after bilateral LPIs, compared with white patients (P = .02). The odds of post-LPI glaucoma medication use increased by 21% for every additional 5 years of age (P < .0001). Most patients undergoing bilateral LPIs received no pre- or post-LPI glaucoma medication-class prescriptions and had no cataract or additional glaucoma surgery within 2 years after LPIs. Clinicians should alert black or older patients and those already taking glaucoma medications before the procedure of their higher odds of requiring medications afterward.