Factors Associated With Gonioscopy Coding Before Glaucoma Procedures in the IRIS^Ⓡ Registry.

Abstract

To analyze nationwide preoperative gonioscopy utilization patterns for various glaucoma surgeries and laser surgeries over time using the IRIS^Ⓡ Registry (Intelligent Research in Sight). Retrospective cohort study. All adults who underwent a glaucoma surgery or laser surgery between January 1, 2014 and April 14, 2023. The first glaucoma procedure from the first eye of each patient was recorded as the index event and time was measured between the most recent preoperative gonioscopy date to the index event. Baseline demographics, preoperative clinical characteristics, glaucoma diagnosis, procedure type, and type of subspecialist performing the procedure were collected. Primary outcome was the percentage of patients who had preoperative gonioscopy coded within 5 years of their glaucoma procedure. Secondary outcomes were the baseline factors that were associated with higher gonioscopy use using multivariable logistic regression. The study included 1.1 million patients (mean age 69.5 ± 12.0 years). A majority had an in-office laser surgery (71.9%), while 16.2% had microinvasive glaucoma surgeries (MIGS), 6.5% had a trabeculectomy or tube (traditional), and 4.6% had other glaucoma surgeries. Preoperative gonioscopy was identified in 63.2% of patients, and 87.0% of those were within 1 year of the index event. In multivariable models, Asian (OR 1.16, 95% CI 1.13-1.18, P < .001) and Black (OR 1.12, 95% CI 1.11-1.14, P < .001) racial groups were associated with higher odds of gonioscopy compared to the White racial group. When compared to traditional surgery, MIGS were associated with lower utilization (OR 0.67, 95% CI 0.65-0.68, P < .001), but in-clinic laser surgeries were not (P = .9). Glaucoma subspecialists were more likely to perform preoperative gonioscopy compared to nonglaucoma subspecialists (OR 2.65, 95% CI 2.61-2.68, P < .001). Preoperative gonioscopy use and/or coding is lower than expected, given current guidelines. Among glaucoma procedures, ab interno MIGS were associated with lower preoperative gonioscopy utilization.