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10 • 2018 ASCRS Clinical Survey Key findings Nearly half of respondents, overall, perform some form of glaucoma surgery and laser procedures (57% percent of U.S. respondents, 34% of non-U.S. respondents), while 28% of respondents, overall, only offer medical glaucoma practice. Most of those who perform laser trabeculoplasty do so after first-line medications (40%), however, 27% of U.S. physicians will initiate laser trabeculoplasty as a first-line treatment. Nearly 50% of respondents use some form of microinvasive glaucoma surgery (MIGS), but U.S. respondents were almost two times more likely to do so compared to non-U.S. respondents. "Certainly the attitude about laser trabeculoplasty has shifted over the last 2 decades. When argon laser trabeculoplasty was the only modality available, it was reserved for cases that were usually on medi- cations first; it was rarely used as a primary therapy. With selective laser trabeculoplasty (SLT)—which is more comfortable for patients, doesn't damage the trabecular meshwork, and is repeatable—there has been an increase in primary use. What's more, I think people respond better to virgin treatment with SLT than if they had already been on a prostaglandin. With regard to MIGS, I think the survey shows MIGS is here to stay. The bottom line is MIGS is safe and effective, and that message is getting out there. This safety factor is why ophthalmologists are increasing- ly comfortable using MIGS in the majority of cases." —Steven Sarkisian Jr., MD ASCRS Glaucoma Clinical Committee Glaucoma Do you perform any glaucoma surgery (including MIGS or laser procedures)? • Overall, nearly half of respondents perform glaucoma surgery and laser procedures, 49% • U.S. 23% points higher than Non-U.S., 57% to 34% • Overall, 28% of respondents only have a medical glaucoma practice • Non-U.S. 17% points higher than U.S., 39% to 22% n=838 124 When do you initiate laser trabeculoplasty for your glaucoma patients? • Overall, no response was selected by a majority of respondents • Highest: After first-line medication, 40% • U.S. 2nd Highest: First line, 27% • Non-U.S. 2nd Highest: After three medications, 22% n=527 125 Which incisional glaucoma surgical procedures do you perform? (Select all that apply) • Overall, Schlemm's Canal based surgery, 65% • U.S.: 80% • Non-U.S.: 32% • Overall, Trabeculectomy, 53% • U.S.: 40% • Non-U.S.: 80% n=485 127 Of your surgical cataract patients with glaucoma, which of the following best describes your use of/interest in Microinvasive Glaucoma Surgery (MIGS)? • Overall, 49% of respondents are using MIGS • 27% Do not plan to offer in the next 12 months • U.S. respondents are using MIGS at nearly twice the rate of Non-U.S. respondents, 58% to 31% • 29% of U.S. respondents use MIGS in the majority of their surgical cataract patients with glaucoma, Non-U.S. 5% All 22% US 28% NonUS 8% Average Pct n=654 133 What percentage of your glaucoma patients would you estimate are candidates for a Microinvasive Glaucoma Surgery (MIGS)? (Even if you aren't currently performing this surgery) • Overall, on average respondents estimate 21% of their glaucoma patients are candidates for MIGS • 25% of U.S. respondents estimate more than 40% are candidates for MIGS, more than 3 times the rate of Non-U.S. respondents, 8% • U.S. respondents are 10% points higher than Non-U.S., 24% to 14% for Non-U.S. All 21% US 24% NonUS 14% Average Pct n=431 134

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