Ophthalmic Surgery

Association of Smoking with Glaucoma Surgery and Uveitic Glaucoma: A National Database Cohort Study Alexander T Hong, BS, Jason Chwa, BS, Brian Toy, MD Keck School of Medicine - University of Southern California, Los Angeles, CA; Keck Medical Center of University of Southern California, Los Angeles, CA Introduction: Glaucoma is a leading cause of vision loss worldwide. Smoking is a risk factor for ocular disease, mediated through oxidative stress. Its role in glaucoma disease progression, to incident glaucoma in extant inflammatory eye disease and to glaucoma surgery overall, is unknown. Methods: A retrospective cohort study using TriNetX, a national electronic health records network, identified glaucoma (including primary open-angle glaucoma [POAG] and angle-closure glaucoma [ACG]) and uveitis patients followed for up to 20 years. The exposure was smoking status, dichotomized to ever vs never. The primary outcome was glaucoma surgery, with glaucoma and uveitic glaucoma development as a secondary outcome in uveitis patients. Propensity score matching balanced demographics, comorbidity, medication, and healthcare use between smoking and non-smoking cohorts. Hazard ratios (HR) with 95% CI were reported. Results: Matched cohorts included 243,013 glaucoma and 33,898 uveitis patients. In glaucoma patients, ever smoking was associated with an increased risk of glaucoma surgery (HR 1.15, 95% CI 1.12-1.19), consistent in POAG (HR 1.35, 95% CI 1.18-1.55) but not ACG (HR 0.93, 95% CI 0.68-1.26) subgroups. In uveitis patients, smoking was associated with an increased risk of glaucoma surgery (HR 1.25, 95% CI 1.15-1.36) and uveitic glaucoma (HR 1.20, 95% CI 1.09-1.33), but not new glaucoma diagnosis (HR 1.04, 95% CI 0.99-1.09; Figure 1). Conclusion: Smoking exposure increases the risk of surgical glaucoma in patients with glaucoma and uveitis. Among uveitis patients, smoking increases the risk for uveitic glaucoma. Smoking cessation counseling is critical to reduce glaucomatous vision loss among at-risk patients.Figure 1Ophthalmology Coverage for Emergency and Trauma Call: Factors That Improve Patient Care and Trauma Medical Director Satisfaction Lester H Lambert, MD, Brittany E Powell, MD, FACS, Gregory J Zarow, PhD, Robert A Mazzoli, MD, FACS, Avery B Nathens, MD, PhD, FACS, Boonkit Purt, MD, FACS Marine Air Support Squadron-3, Camp Pendleton, CA; Department of Ophthalmology, Naval Medical Center San Diego, San Diego, CA; Combat Trauma Research Group, Naval Medical Center San Diego, San Diego, CA; Department of Ophthalmology, Madigan Army Medical Center, Beaverton, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada Introduction: Ocular trauma accounts for one-third of all emergency room visits in the US and prompt, high-quality care by ophthalmologists is crucial for patient outcomes. However, no previous studies have been specifically designed to identify the drivers of satisfaction with emergency coverage in trauma medical directors. Methods: Trauma call directors from Level I, II, and III trauma centers (n = 260) completed a 22-item survey. Satisfaction was rated on a 5-point scale (extremely unsatisfied to extremely satisfied). Data were analyzed using ANOVA and linear regression statistics at p < 0.05. Results: Adequacy of call coverage was significantly associated with satisfaction (p < 0.0001), with 30% indicating that call coverage was a significant problem. Response time (p < 0.0001), having an ophthalmologist on staff (p < 0.0001), and having ophthalmologists participate in trauma coverage (p < 0.0001) were associated with greater satisfaction, while transfer time, fee structure, and additional compensation for trauma call coverage were not (p > 0.05). Having proper equipment on site and being at a Level I trauma center significantly interacted toward greater satisfaction (p < .0001). Tele-ophthalmology was available at 3.5% of sites, but only 16.2% indicated that they would not use tele-ophthalmology if available. Conclusion: Present findings indicate that call coverage, fast response times, having properly equipped on-site ophthalmologists to treat ocular trauma in emergency settings foster satisfaction in trauma medical directors. Furthermore, tele-ophthalmology has potential but is presently largely unavailable. Combined, present findings highlight the importance of studying drivers of satisfaction in trauma medical directors toward providing prompt, high-quality care for emergency medicine patients with ocular trauma. ABSTRACT WITHDRAWN The Impact of GLP-1 Receptor Agonists on Ophthalmic Surgery Rates in Type 2 Diabetes Mellitus: A Global TriNetX Analysis Rose Bishay, BS, Hasson Abdel, BS, Urva Patel, BS, Yash A Mehta, BS, Akciree Knight, BA, Ericka Knight, BA, Logan D Karlen, BS, Shashank Coorapati, BS, Sherif Hassan, MD, PhD University of California, Riverside School of Medicine, Riverside, CA Introduction: With the rising demand for GLP-1 receptor agonists, it is important to evaluate their effects on ophthalmic disease progression and the resulting differences in surgery rate among patients with type 2 diabetes mellitus (T2DM). This study compares the rate of ophthalmic operation in T2DM patients treated with GLP-1 receptor agonists vs those not treated with these drugs. Methods: This retrospective study used the TriNetX database. Cohort 1 included T2DM patients taking GLP-1 analogues (n = 617,507), while Cohort 2 included T2DM patients not taking GLP-1 analogs (n = 3,185,340). Outcomes compared included vitrectomy, trabeculectomy, aqueous shunt implantation, and phacoemulsification. Patients under 18 years old, over 65 years old, or with previous ophthalmic operation before T2DM diagnosis were excluded. Propensity score matching was applied to balance 25 variables including demographics, comorbidity, medication (insulin and metformin), and labs (HbA1C levels). Results: After matching (n = 396,046), GLP-1 use was associated with higher risk of phacoemulsification (risk ratio: 0.877, p < 0.0001). The non-GLP-1 treated cohort had an increased risk of trabeculectomy (risk ratio: 1.311, p = 0.0017) and aqueous shunt implantation (risk ratio: 1.291, p = 0.0046). Vitrectomy rates did not differ significantly (Table 1). Conclusion: GLP-1 use in T2DM patients may increase phacoemulsification rate, a commonly used operation to alleviate cataracts. Conversely, GLP-1 treated patients were less likely to undergo trabeculectomy or aqueous shunt implantation, suggesting that GLP-1s may decrease the progression of glaucoma and need for glaucoma surgery. Further studies are needed to confirm these findings and understand the underlying mechanisms. Table 1. - Post-Matching Results Outcomes p Value Risk Ratio 95% CI Vitrectomy 0.7008 1.019 (0.927,1.12) Trabeculectomy 0.0017 1.311 (1.106,1.553) Aqueous Shunt Implantation 0.0046 1.291 (1.081,1.542) Phacoemulsification <0.0001 0.877 (0.831,0.927) ePosters Associations Between Social Determinants of Health and Glaucoma Surgery Acceptance and Refusal Rates Melodyanne Cheng, MS David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA Introduction: This study aims to assess and understand the possible underlying social determinants of health (SDOH) affecting patient acceptance and refusal of glaucoma surgery to better support health-seeking behaviors around glaucoma management and increase adherence to recommended glaucoma surgical interventions. Methods: Demographic and clinical data was collected from the electronic medical records of each study participant. Decision for surgery acceptance or refusal was noted as a primary outcome. Linear regressions were used to statistically analyze for associations between SDOH variables and surgical decision outcome. Kaplan-Meier failure curves for each SDOH variable were modeled to demonstrate incidence rate of surgery decision outcomes. Results: 108 total patients were included (69 from 2020-2021 and 39 from 2023 to 2024). 83% of patients in the 2020-2021 cohort initially accepted surgery and 17% refused, as compared with the 56% of patients who accepted and 44% who refused in the 2023-2024 cohort (p = 0.006). History of depression was significantly associated with LogMAR (p = 0.02). History of anxiety was statistically significant in patients who had were first time surgical candidates, as well as patients who had prior surgery in that eye (p = 0.01). History of anxiety was also statistically significant with surgery decision-making. Conclusion: This study provides a statistically rigorous view of the various factors that may impact a veteran patient’s decision-making and seeks to support providers navigating the complexity of counseling patients for glaucoma surgery. Micro-Invasive Glaucoma Surgery (MIGS) and Cataract Surgery (CS) Clinical Trials for Patients with Glaucoma: An Analysis on Efficacy and Patient Representation Abdullah Virk, BS, Jeremy Appelbaum, BA, Karen M Allison, MD, FACS Flaum Eye Institute, University of Rochester, Rochester, NY; School of Medicine, New York Medical College, Valhalla, NY Introduction: Glaucoma is the leading cause of global irreversible blindness that disproportionately affects people of African descent. There are a number of interventions available to treat glaucoma including MIGS, whose usage has drastically increased due to its safety and efficacy. The objective of this study is to compare the IOP and medication reduction as well as the representation and outcome of participants between MIGS, CS, and MIGS and Cataract Surgery (MACS) trials. Methods: This analysis consisted of publicly available data on MIGS, CS, and MACS clinical trials from 2005 to 2017 using ClinicalTrials.gov as well as prevalence data sourced from the CDC. The primary outcomes were the baseline, post-procedure, and reduction in IOP and glaucoma medication use as well as the participation to prevalence ratio (PPR) of each clinical trial. Results: A total of 21 trials were included in this review, comprising 3294 clinical trial participants: 577 in CS cohorts, 1525 in MIGS cohorts, and 1167 in MACS cohorts. At 12 months, IOP reduction (mmHg) was 6.94 for CS, 8.85 for MIGS, and 8.21 for MACS. The medication reduction was 0.83 after CS, 1.03 for MIGS, and 1.27 for MACS. The overall PPR of Black participants was found to be 0.44. Conclusion: The results indicate that CS, MIGS, and MACS all result in a significant decrease in IOP and glaucoma medications; however, MIGS and MACS outperform CS. Additionally, CS, MIGS, and MACS clinical trials underrepresent Black individuals, which raises concerns about the generalizability of the studies. Near Vision Outcomes with Monofocal Intraocular Lens Post-Cataract Surgery Muhammad Bilal, MBBS Al Ibrahim Eye hospital, Karachi, Pakistan Introduction: Cataract surgery with IOL implantation restores vision, but traditional monofocal IOLs can struggle with near vision tasks. Aspherical monofocal IOLs, designed to reduce spherical aberration, improve image quality and may offer a better solution for near vision needs. They provide enhanced contrast sensitivity and clarity, especially for high near vision demands. Methods: Inception trial (retrospective + prospective cohort) at Jawaid Eye Hospital (May 2024 - Apr 2026). Patients undergo comprehensive exams (visual acuity, refraction, ocular biometry, slit lamp, etc.). ERC approval and informed consent obtained. Results: Paired t-tests and Wilcoxon Signed-Rank Tests assessed pre- and postop visual outcomes. Postop near VA improved by 4.1 units (to N8 mean, p = 0.073), but not significantly. Other comparisons were not significant, likely due to small sample size. Age and axial length showed weak, non-significant correlations with visual outcomes. Comorbidities like hypertension, diabetes, cardiac conditions, and smoking had no significant impact, though diabetes mildly reduced visual acuity. Conclusion: In conclusion, the study suggests that aspherical monofocal IOLs may offer some improvement in near vision post-cataract surgery, though the results were not statistically significant. Visual outcomes were generally not affected by factors like age, axial length, or common comorbidities, though diabetes showed a potential negative impact on visual acuity. The small sample size may have limited the ability to detect significant differences, indicating the need for further research with larger cohorts to confirm these findings. Outcome of Standard Dual Therapy of Coats Disease in a Tertiary Eye Care Center of Bangladesh Jasmin Ahmad, MBBS, FACS Bangladesh Eye Hospital, Chattogram, Bangladesh Introduction: To evaluate the outcome of standard management of Coat’s disease presenting in a tertiary eye care center. Methods: A retrospective record based case series of 20 eyes of 20 cases of Coats disease presented at Chittagong Eye Infirmary & Training Complex from January 2008 to June 2019. The Data included classification of disease, quadrant of retina involved; best corrected visual acuity (BCVA) before and after treatment and treatment details (Laser Photocoagulation and/or injection bevacizumab) with prognosis. Results: The mean age of study cases was 24.75 (±1.645) years, 60% of them were male. Among 20 affected eyes 80% had 4, 10% had 3 and 10% had 2 quadrant involvement. According to severity of disease, 20% showed stage 5, 50% 3B, 10% 3A, 15% 2B and 5% 2A stage of disease. 85% eyes presented with severe and 15% with moderate visual impairment. After treatment the final BCVA of 5% eye was 6/9; 20% eyes was 6/60 or better and 75% eyes remain less than 6/60.The mean number of injection bevacizumab was 2.4 (±2.643). 25% did not receive any injection as in very advanced stage. Laser photocoagulation was conducted in 80% eyes with mean number 1.60 (±1.35).The mean follow up time was 25.95 (±2.76) months. During the follow up period 8 (40%) eyes experienced improvement of vision, 35% eyes vision remain stable. Conclusion: Appropriate intervention with combine treatment improving the overall outcome including vision. Delayed presentation and severe stage of disease are cases of poor prognosis.

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