Factors Associated With Favorable Laser Trabeculoplasty Response: IRISRegistry Analysis

Purpose: We examined patients in a large clinical registry to assess factors associated with laser trabeculoplasty (LTP) responses. Design: Retrospective cohort study. Methods: STUDY POPULATION: LTP patients in the Intelligent Research in Sight (IRIS) Registry, 2013-2018. OBSERVATION: IRIS Registry data were extracted if the eye had a procedural code for LTP and a glaucoma diagnosis. Eyes were excluded if LTP laterality or baseline intraocular pressure (IOP) could not be determined. Following LTP, “nonresponders” were those with <20% IOP reduction after 8 weeks, while “responders” were those with ≥20% IOP reduction. MAIN OUTCOME MEASURES: Proportion of responders, odds ratios (OR) of pre-LTP factors associated with being a nonresponder. Results: A total of 263,480 eyes were included, with mean age 71.4 ± 11.7 years. Mean baseline IOP was 19.1 ± 5.0 mm Hg, mean number of pre-LTP medications was 2.1 ± 1.5. Response rate was 36.9% overall and 68.8% for those with baseline IOP >24 mm Hg. Higher baseline IOP was associated with reduced odds of nonresponse (OR = 0.60, P < .0001 for a 3 mm Hg increase). Angle recession, uveitis, and aphakia increased the odds of a nonresponse (ORs 2.46, 1.50 (both P < .0001), and 1.55 (P = .0259), respectively). In nonresponders with at least 1 medication at baseline, 76.3% of eyes had fewer medications postoperatively. Conclusions: Lower baseline IOP, angle recession, uveitis, and aphakia were associated with increased odds of nonresponse. Future studies that analyze LTP responder survival and implementation lag would facilitate resource optimization in glaucoma therapy.