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6 | 2019 ASCRS CLINICAL SURVEY CLINICAL SURVEY 2019 Glaucoma When asked when they most commonly initiate laser trabeculoplasty for glaucoma patients, 28.8% of respondents said they use it after first-line medication, while 24.8% said they do not perform laser interventions. Respondents also weighed in on which incisional glaucoma surgical procedures they perform, with the highest per- centage (48%) saying that they do not perform incisional glaucoma surgical procedures; 36.6% did perform trabeculectomy. "The data shows that only 18% of respondents offer laser trabeculoplasty as a first-line option for their glaucoma patients. The recently published LiGHT study was a randomized controlled trial comparing eye drops vs. selective laser trabeculoplasty (SLT) as first-line therapy in glaucoma patients; 356 patients were randomized to SLT and 362 patients were randomized to drops, and patients were followed for 3 years. At the end of the follow-up period, none of the SLT-first patients required incisional glaucoma surgery, whereas 11 of the eye drop-first patients required glaucoma surgery. The results of the LiGHT study do suggest that a paradigm shift in the first-line management of our glaucoma patients is underway. "I was surprised to see that more than one-third of the respondents said that they are performing trabeculectomy surgery, which is the gold standard glaucoma filtration procedure. By most accounts, fewer trabeculectomy procedures are being performed throughout the U.S., being replaced by glaucoma drainage device (GDD) procedures and MIGS. The main impetus behind the paradigm shift is the safer risk profile with GDD surgery and MIGS. These data are even more surprising given the fact that almost 70% of the respondents consider themselves cataract/anterior segment surgeons or comprehensive ophthal- mologists. We do have an opportunity to teach MIGS techniques to our colleagues so that they might offer these less invasive procedures to their patients with mild to moderate glaucoma." Leon Herndon, MD ASCRS Glaucoma Clinical Committee WHICH ANSWER BEST DESCRIBES WHEN YOU MOST COMMONLY INITIATE LASER TRABECULOPLASTY FOR YOUR GLAUCOMA PATIENTS? WHICH INCISIONAL GLAUCOMA SURGICAL PROCEDURE DO YOU PERFORM? (Select all that apply.)

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