In a retrospective chart review, researchers from Wills Eye Hospital’s glaucoma research center, Sidney Kimmel Medical College and the Department of Biostatistics at Thomas Jefferson University evaluated the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy in patients with open-angle glaucoma.

In this study, researchers conducted a chart review of adult patients who underwent GATT due to inadequately controlled intraocular pressure or poor tolerance to medication. Main outcome measures were success rate, IOP and number of glaucoma medications. Success was defined as IOP reduction >20 percent from baseline or IOP between 5 and 21 mm Hg, and no need for further glaucoma surgery. When success criteria were not met for any postoperative visit longer than three months after surgery, failure was determined.

In total, 66 patients, average age 62.9 ±14.9 years (50.8-percent female) were included in the analysis. Average follow-up was 11.9 months (range: three to 30 months) and overall success rate was 63 percent. Mean IOP was 26.1 ±9.9 mmHg preoperatively and 14.6 ±4.7 mmHg at 12 months (a 44-percent IOP decrease; p<0.001). Mean number of medications decreased from 3.1 ±1.1 preoperatively to 1.2 ±0.9 at 12 months (p<0.001). The rate of hyphema at one week and one month postoperatively was 38 percent and 6 percent, respectively. Overall GATT success rates among white and black patients were 69 percent and 42 percent, respectively, which was statistically significant (p<0.05).

The future of GATT as a minimally- invasive glaucoma surgery in adults seems promising, these researchers claim. This position is supported by GATT’s low rate of long-term complications and the conjunctiva-sparing nature of the surgery.

J Glaucoma 2017 Dec;16:1137-1143
Rahmatnejad K, Pruzan NL, Amanullah S, et al.

Savings From Research
Researchers compared patient and Medicare savings from the use of optical coherence tomography in guiding therapy for neovascular age-related macular degeneration, with funding from the National Institutes of Health and the National Science Foundation in developing OCT, as part of an observational cohort study. (Several of the study’s authors have a financial interest in OCT devices and/or companies.)

The main outcome measures were spending by Medicare, as tracked by Current Procedural Terminology codes for intravitreal injections (67028), retinal OCT imaging (92134) and anti-vascular endothelial growth factor treatment–specific J-codes (J0178, J2778, J9035, J3490 and J3590). Researchers identified claims using the Medicare provider utilization and payment data from the Centers for Medicare and Medicaid Services among fee-for-service Medicare beneficiaries from 2012 to 2015; 2008 claims were acquired from the 100-percent FFS Part B Medicare claims file. Researchers determined OCT research costs by searching for grants awarded by the NIH and NSF from inception to 2015. They discounted all costs and savings by 3 percent annually and adjusted for inflation to 2015 dollars.

The researchers determined that between 2008 and 2015, the U.S. government accrued an estimated savings of $9 billion, while nvAMD patients saw an estimated savings of $2.2 billion, from the use of OCT to guide personalized anti-VEGF treatment. The $9 billion represents a 21-fold return on government investment into developing the technology through NIH and NSF grants, they added.

 The researchers added that, although an overall cost-benefit ratio of government-sponsored research is difficult to estimate because the benefit may be diffuse and delayed, their findings reveal that the investment in OCT over two decades was recouped many times over within a few years through better personalized therapy.

Am J Ophthalmol 2017;185:115
Windsor MA, Sun SJJ, Frick KD, et al.