Most Glaucoma Surgeries Performed in Urban Areas, Mimicking MD Access Patterns

Trabecular microbypass was the only procedure less likely to be done in urban areas, commonly performed by cataract surgeons who may be more likely than glaucoma subspecialists to practice in non-urban areas. Pictured: the Hydrus Microstent. Photo: Derek N. Cunningham, OD, and Walter O. Whitley, OD. Click image to enlarge. Geographic disparities in glaucoma surgeries across the United States are known but haven’t been extensively studied, and mostly focused on Medicare claims data, with particular attention to minimally invasive glaucoma surgeries (MIGS). In a recent study, researchers evaluated access to glaucoma surgical care by quantifying the geographic distribution of glaucoma surgeries across the United States. They found the odds of receiving nearly all types of glaucoma surgery are significantly higher in urban areas. The findings were reported earlier this week in Ophthalmology.A total of 537,182 glaucoma procedures from 346,473 patients between 2013 and 2019 from the IRIS Registry were included. The ones most performed were trabecular microbypass (iStent and Hydrus, 38.6% of cases) and trabeculectomy (12.1% of cases). Urban practice locations accounted for most surgeries (91%), with 96% of glaucoma subspecialists and 88% of non-glaucoma ophthalmologists performing surgeries exclusively in such settings.Comparing patient residence to place of surgery, 47% needed to travel to a different “district,” represented by the first three digits of a postal zip code. “Though the geographic areas of districts vary, they typically represent sections of a large city or aggregations of towns,” the researchers explained in their paper. Only 8% needed to travel to a different region, however. Region is denoted by the first digit of a zip code; there are 10 in all.Trabeculectomy (11%) and tube shunt implantation (10%) were the procedures with their highest proportion of cases involving inter-region travel.Only trabecular microbypass was less likely to be performed in urban areas, and the authors noted this procedure is commonly performed by non-glaucoma specialists (i.e., cataract surgeons) who may be somewhat more likely than glaucoma subspecialists to practice outside of urban areas.“This may represent challenges to patients with advanced glaucoma who live in non-urban areas, particularly because traditional glaucoma surgery (i.e., drainage devices and trabeculectomy) are among the most common procedures for which patients must travel across districts and regions,” the authors wrote in their Ophthalmology paper. “Future studies may examine data at the surgeon level, rather than at the procedure level as done here, to elucidate disparities in access to glaucoma subspecialists.”Access-to-care constraints are present in many aspects of eye surgery, given the propensity of ophthalmologists to concentrate in cities. “Our results demonstrate that patients often travel for specialty glaucoma care with about half of all procedures conducted in practices that were not in patients’ home districts and almost one in 10 procedures conducted in practices that were not in patients’ home regions,” the authors explained in their report.It should be noted that distance perception varies by individual and context, and glaucoma surgeries are not required frequently, the authors added in their paper.“Though impact of spatial access to care on health outcomes is a nascent field, work in other medical disciplines that involve life-threatening conditions has suggested that farther distances to surgical centers lead to worse patient outcomes, suggesting geographic barriers could be shared health equity concerns,” the researchers wrote.“The results presented here demonstrate the need for increased availability of more precise geographic data, more robust quantification of geographic disparities and more proactive public health and workforce planning measures to ensure patients in all parts of the United States have equitable access to glaucoma surgery,” the authors concluded in their paper.Click here for the journal source. Lokhande A, Aziz K, Fujita A, et al. Geographic distribution of access to glaucoma surgery: an IRIS Registry Analysis. Ophthalmology. July 14, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.