Eyeworld

HIGHLIGHTS FROM THE 2025 ASCRS CLINICAL SURVEY Glaucoma From the ASCRS Clinical Survey data, we see some encouraging responses in our membership, as well as areas for future growth. Almost a third (29%) of physicians who treat glaucoma are using SLT as the primary therapy, and this is a positive sign. The LiGHT trial 1 has likely given us confidence to use this laser as the first step in treatment. On the other side of the coin, 37% of re- spondents are not performing laser treatment. This suggests that we have a problem with ac- cess to the laser technology, as well as a possible lack of comfort with the treatment procedure itself. The advent of direct SLT could address both of these issues. Hopefully, we will see this number shrink as that technology becomes more available. In terms of MIGS, surgeons are performing a variety of treatments, and I think that this is appropriate and demonstrates the wealth of options and approaches today. Trabecular bypass stents have a small lead, and this is likely appro- priate given their FDA approval and reimburse- ment coverage. We also see a number of other procedures— such as goniotomy (30%), canaloplasty (21%), transscleral cyclophotocoagulation (12%), transscleral gel stent (8%), and endoscopic cyclophotocoagulation (8%)—which hopefully demonstrates that our surgeons are tailoring therapy to the individual patient. Finally, we see that incisional glaucoma surgery (trabeculecto- my and tubes) is still needed today, with trabe- culectomy at 22% and tube shunts at 16%. —Nathan Radcliffe, MD ASCRS Glaucoma Clinical Committee Chair Reference 1. Gazzard G, et a l. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393:1505–1516. n=981 Which answer best describes when you most commonly perform laser trabeculoplasty? After first-line medication 16% 29% First line After two medications 10% When medications are not tolerated 8% I do not perform laser interventions 37% n=981 Which glaucoma procedures do you perform? (Select all that apply) 16% Tube shunt 12% Transscleral cyclophotocoagulation 8% Transscleral gel stent 8% Endoscopic cyclophotocoagulation 13% Other 34% I do not perform incisional glaucoma surgical procedures Trabecular bypass stents 30% 30% Goniotomy 21% Canaloplasty 22% Trabeculectomy

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