Demographic and Clinical Characteristics Associated with Minimally Invasive Glaucoma Surgery Use: An Intelligent Research in Sight (IRIS®) Registry Retrospective Cohort Analysis

Abstract

Minimally invasive glaucoma surgery (MIGS) is increasingly performed at the time of cataract extraction. Understanding the demographic and clinical characteristics of patients undergoing MIGS procedures may provide insight into patient selection. This study evaluates racial-ethnic and other differences in the utilization of MIGS in persons with cataract and open-angle glaucoma (OAG). Retrospective cohort study using IRIS® (Intelligent Research in Sight) Registry data. U.S. patients aged ≥40 years with a diagnosis of OAG and no history of MIGS or cataract surgery who were undergoing cataract extraction, with or without MIGS, during 2013-2017. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Variables assessed include age, sex, race-ethnicity, disease severity, insurance type, census region, comorbidity, and cup-to-disc ratio (CDR). The odds of MIGS utilization was greater among patients who were >60 years (OR, 1.10 [95% CI, 1.05-1.16]); African American (OR, 1.11 [CI, 1.07-1.15]), compared with white; a Medicare recipient (OR, 1.12 [CI, 1.10-1.15]), , versus privately insured; or in the Midwest (OR, 1.32 [CI, 1.28-1.36]) or Northeast (OR, 1.26 [CI, 1.22-1.30]), compared with the South. Having moderate, rather than mild, glaucoma (OR, 1.07 [CI, 1.04-1.11]) and a higher CDR (OR for 0.5 to 0.8, vs. <0.5, 1.24 [CI, 1.21-1.26]; OR for >0.8 to 1.0, vs. <0.5, 1.27 [CI, 1.23-1.32]) were also each associated with increased odds of MIGS utilization. MIGS was less likely in females (OR, 0.96 [CI, 0.94-0.98]); patients taking 5 to 7 glaucoma medications (OR, 0.94 [CI, 0.90-0.99]), compared with 1 to 2 medications; and patients with severe, compared with mild, glaucoma (OR, 0.64 [CI, 0.61-0.67]). To our knowledge, the IRIS Registry contains the largest cohort of U.S. patients with MIGS procedures reported to date. This analysis highlights the importance of capturing race-ethnicity data and other pertinent patient characteristics in electronic health records to provide insight into practice patterns. Such data can be used to assess the long-term performance of MIGS and other procedures in various patient populations.