An IRIS Registry-Based Assessment of Primary Open-Angle Glaucoma Practice Patterns in Academic Versus Nonacademic Settings

Abstract

To compare patient demographic data; level of severity; and clinical, diagnostic, and surgical practice patterns in patients with primary open-angle glaucoma (POAG) in an academic setting vs nonacademic setting using the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight). A retrospective cohort study of IRIS Registry data that included patients with POAG who were seen between January 2016 and December 2019 and had at least 1 year of follow-up. Of 3 707 084 distinct eyes with POAG, 3% (109 920) were included in the academic subcohort and 97% (3 597 164) were included in the nonacademic subcohort. Among the findings of greatest note (P < .0001 for all comparisons) were a higher proportion of eyes of Black patients, a higher proportion of eyes with level 3 severity, and a higher mean cup-to-disc ratio in eyes in the academic setting. The relative frequency of gonioscopy, pachymetry, and visual field testing in conjunction with new patient visits was also notably higher in the academic setting. For glaucoma surgical procedures, the greatest proportional differences in relative frequency were seen for tube shunt procedures (2.55-fold higher in the academic setting), iStent and Hydrus procedures (2.52-fold higher in the nonacademic setting), and endoscopic cyclophotocoagulation (5.80-fold higher in the nonacademic setting). Based on IRIS Registry data, notable differences appear to exist with regard to ethnoracial groups, glaucoma severity, and diagnostic and surgical practice patterns in academic vs nonacademic settings. By understanding these differences, potential opportunities exist in the development of educational programs related to clinical and surgical glaucoma care.