Jesse James M Lu*, Rainier Victor A Covar and Darby E Santiago
Department of Ophthalmology and Visual Sciences, Sentro Oftalmologico Jose Rizal, University of the Philippines - Philippine General Hospital, Taft Avenue, Metro Manila, Philippines
*Corresponding Author: Jesse James M Lu, Department of Ophthalmology and Visual Sciences, Sentro Oftalmologico Jose Rizal, University of the Philippines - Philippine General Hospital, Taft Avenue, Metro Manila, Philippines.
Received: July 13, 2022; Published: July 19, 2022
Purpose: Neovascular glaucoma (NVG) is a dreaded form of secondary glaucoma characterized by neovascularization of the iris, the angle, or both, and elevation of intraocular pressure (IOP). Because of the complex nature of the disease, its treatment often warrants a multi-disciplinary approach that inevitably lead to variations in treatment protocols. In this research, we are interested in determining the different treatment practices in the management of NVG among general ophthalmologists, glaucoma specialists and retina specialists based on the presenting stage of the disease.
Objective: This study aimed to compare the different treatment practices among general ophthalmologists, glaucoma and retina subspecialists in the management of neovascular glaucoma.
Methodology: A cross-sectional survey study among general ophthalmologists, glaucoma and retina specialists who are members of the Philippine Academy of Ophthalmology (PAO) was conducted. The survey, drafted by a general ophthalmologist, a glaucoma specialists and a retina specialist, comprised of seventeen questions in multiple choice format with two parts. The first part included questions pertaining to participant demographics, while the second part consisted of questions pertaining to their NVG management practices.
Results: One hundred and sixty four (164) respondents were included in the survey comprising of 67 general ophthalmologists, 47 glaucoma specialists and 50 retina specialists. Most of the participants practice in an area with an available retina and glaucoma specialist, and have access to anti-vascular endothelial growth factor (anti-VEGF) medication or pan-retinal photocoagulation (PRP). The participants have varied years of practice or experience. On the average, general ophthalmologists and retina specialists (VRSP) are able to see less than 1 case of NVG per month; whereas glaucoma specialists (PGS and non-PGS) and retina specialists (non-VRSP) are able to see more than 1 case of NVG per month. The most common first line medication used by almost all subspecialty with an IOP between 30 and 40 mmHg is a beta blocker. On the other hand, the most common first line medication used by all subspecialty for IOP of more than 40 mmHg is an oral carbonic anhydrase inhibitor (CAI). The usual and preferred anti-VEGF drug used by all subspecialties is bevacizumab. All ophthalmologists perform and prefer to do IOP surgery within 7 days after anti-VEGF injection. During the early stage of the disease, majority of the respondents will either inject anti-VEGF or perform PRP. Forty percent of glaucoma specialists will refer the patient to a retina specialist. During the open angle stage, only 60% of general ophthalmologists will manage the disease on their own either with anti-VEGF inejction of PRP. Forty percent of them will either refer to a glaucoma or a retina specialist. During the angle closure stage, majority of the respodents would inject anti-VEGF as their initial management. One-third of general ophthalmologists will refer to either a glaucoma or a retina specialist. Twenty one percent of glaucoma specialists will immediately refer the patient to a retina specialist, while 12% of retina specialists will refer to a glaucoma specialist. Trabeculectomy was the IOP lowering surgery of choice of general ophthalmologists during this stage, whereas the glaucoma specialists preferred glaucoma drainage device (GDD) implantation.
Conclusions: The survey identified similarities and differences in practice patterns between specialist and non-specialists in our local setting. It highlighted the complexity of NVG management and the different treatment approach by different specialties. Although there was an agreement between both general and subspecialty practice for the use of anti-VEGF medication as first line treatment as shown in the study, differences exist within the practice regarding the next step in the management. Thus, a need for a consensus or society guidelines regarding NVG management may be necessary to reduce these discrepancies for the sake of a more prompt and efficient therapy.
Keywords: Neovascular Glaucoma; anti-VEGF; Pan-retinal Photocoagulation; Trabeculectomy; Glaucoma Drainage Device; Philippines
Citation: Jesse James M Lu., et al. “Trends in Practice Patterns of General Ophthalmologists, Glaucoma and Retina Specialists on the Management of Neovascular Glaucoma in the Philippines".Acta Scientific Ophthalmology 5.8 (2022): 58-68.
Copyright: © 2022 Jesse James M Lu., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.