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Evaluating variance in the medical and surgical management of neovascular glaucoma

PurposeThere remains a significant paucity in data on the epidemiology and management of neovascular glaucoma (NVG). We aimed to describe NVG incidence rates and establish variance in the medical and surgical management of NVG over a 6‐year period, in the context of pathway modifications implemented in response to the COVID‐19 pandemic.MethodsPatients diagnosed with and treated for NVG at our centre between January 2015 and April 2021 were identified. Data on patient demographics, co‐morbidities, aetiology and intervention were extracted. Crude incidence rates were calculated. Variation in the form of intervention and severity of disease practice was studied. Multivariate regression modelling was used to look for associations with disease potentially influencing practice.ResultsFive‐hundred seventy seven patients (M:F 327:250) were included with mean age (SD) 70.26 (12.62), baseline cup‐to‐disc ratio (CDR) 0.75 (0.23), and intraocular pressure (IOP) 28.08 mmHg (14.01). Majority of patients were diabetic (63.9% n = 368). Retinal vein occlusion was identified in 35.0% (n = 203). NVG incidence in the 5 years pre‐COVID were 2.5/100 000 (2015), 4.9/100 000 (2016), 7.8/100 000 (2017), 11.5/100 000 (2018) and 15.8/100 000 (2019) (p < 0.0001), and during COVID 11.8/100 000 (2020). Between 2018–2019 and 2020–21, there appeared to be an increasing trend towards implementing anti‐VEGF therapy and alternate forms of glaucoma surgery. Diabetes was associated with higher rates of surgical intervention (OR = 3.69, 95% CI 1.40–9.67, p = 0.008). Conversely, patients aged 50–74 were less likely to undergo surgery (OR = 0.46, 95% CI 0.21–0.99, p = 0.048).ConclusionIncidence rates of NVG appear to have increased, with a larger proportion of patients requiring surgical intervention. Discrepancies in these rates suggest a cohort of patients lost during the pandemic;these delayed presentations are likely due to patient reluctance and pandemic workforce redeployment.