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Specific patients more likely to require interventions after LPI
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Older patients, as well as other specific patient groups, were found to require more medications after laser peripheral iridotomy, researchers reported in a study recently published in the American Journal of Ophthalmology.
Bansal and colleagues conducted a retrospective longitudinal cohort study to assess glaucomatous interventions following laser peripheral iridotomy (LPI).
Researchers identified 1,660 patients in a managed care network who underwent bilateral LPIs from 2001 to 2011. Using their information, they analyzed which patients needed glaucoma or cataract surgery with 2 years of their LPIs, as well as patients who experienced changes in medications.
Results showed that 1,280 participants did not use medications before or after their LPIs. Additionally, 251 participants needed more glaucoma medication after the procedure, compared to 44 who required fewer. Within 2 years of their LPI procedure, 167 participants underwent cataract surgery, and 79 underwent glaucoma surgery. Researchers also reported that age and ethnicity contributed to the likelihood a patient would need an intervention post-LPI.
"In this sample of Americans with health insurance, we found that the majority of patients receiving LPI surgery did not undergo additional medical or surgical interventions for glaucoma following the procedures," the authors concluded. "For those patients who had already been receiving pressure-lowering medications before the LPI, most continued to require the same number of medications or more afterwards. Groups of patients who were more likely to require glaucoma medications after the surgery included older patients, blacks, those with intermittent or chronic angle closure glaucoma and those who were already taking glaucoma medications before the LPIs.
“Clinicians can use these findings to help counsel patients of similar sociodemographic profiles who are considering LPI surgery what to expect after the procedure,” they advised. – by Chelsea Frajerman
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
LPI is most often performed as prophylaxis against pupil block in at-risk healthy patients. Rarely are subsequent surgical or medical interventions needed in these cases.
Other indications for LPI include acute and chronic angle closure, plateau iris and pigmentary glaucoma. Intuitively, this second group would be more in need of post-LPI treatments.
Bansal and colleagues in their retrospective longitudinal study have confirmed the intuitively obvious: that older patients, black patients and patients who were on medications prior to LPI were more in need of post-LPI surgery or medication. Interestingly, they suggest we consider their data in counseling individual patients who fit this sociodemographic classification and need LPI.
I would suggest that clinicians continue to do what they are already doing: carefully consider each individual patient and make recommendations based on their patient’s profile and clinical exam, not a broad sociodemographic consideration. While this study might be helpful in justifying laser purchases in underserved communities, it does little to inform modern glaucoma practice.
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