Abstract
Objective
To evaluate the long-term evolution of first-line glaucoma therapy (FLGT) initiated
by ophthalmologists and optometrists.
Design
Retrospective population-based study using validated provincial health care databases.
Participants
194,759 Ontario residents, 66 years of age or older, who received FLGT between 2007
and 2018.
Methods
A total of 194,759 individuals from 12 annual cohorts were enrolled, and rates of
first-line medical treatment (prostaglandin analogue [PGA], beta-blocker, alpha-2-agonist,
and carbonic anhydrase inhibitor) and laser trabeculoplasty (LT) were calculated.
Provider (ophthalmologist or optometrist) rates also were assessed.
Results
Across the entire study period, of the 194,759 enrolled individuals who received FLGT,
60.2% initially received medical treatment and 39.8% underwent LT. Approximately 94.6%
were treated by ophthalmologists. PGA therapy was the most common therapy prior to
2010, whereupon LT became the most common FLGT. By 2015, LT exceeded the total of
all medications as FLGT. The annual rate of initial medication prescriptions by optometrists
rose to 101.4 per 100,000 population between 2011 and 2018. In 2018, PGA and non-PGA
prescription rates by ophthalmologists were 2.6 and 5.0 times higher, respectively,
than prescription rates by optometrists.
Conclusion
LT therapy has become the most common FLGT for Ontario residents 66 years of age or
older. PGAs remain the most frequently prescribed glaucoma medication. While ophthalmologists
continue to provide the majority of FLGT, optometrists now provide a small but growing
fraction of FLGT following the introduction of glaucoma medication prescribing privileges.
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Article info
Publication history
Published online: December 06, 2022
Accepted:
November 9,
2022
Received in revised form:
October 21,
2022
Received:
January 28,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
