Article Text

Download PDFPDF
Changing trends in glaucoma surgery within Australia
  1. Michelle T Sun1,
  2. Reema Madike1,
  3. Sonia Huang1,
  4. Cassie Cameron1,
  5. Dinesh Selva1,
  6. Robert J Casson1,
  7. Christopher X Wong2
  1. 1South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2School of Medicine, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  1. Correspondence to Dr Michelle T Sun, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; michelle.sun{at}


Background Limited data are available on glaucoma surgical trends in Australia.

Methods Nationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals.

Results Although there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p<0.001 for both). When stratified by age group, there was a statistically significant interaction in both trabeculectomy and GDD rates by age groups over time (p<0.001 for both). Trabeculectomy procedures decreased to a greater extent in those aged >60 years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups.

Conclusion Our findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.

  • glaucoma

Statistics from


  • Twitter @MichelleTianSun

  • Contributors All authors meet ICMJE recommendation for authorship. Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: MS, RM, SH, CC, DS, RJC CW. Drafting the work or revising it critically for important intellectual content: MS, DS, RJC CW. Final approval of the version published: MS, RM, SH, CC, DS, RJC, CW. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: MS, RM, SH, CC, DS, RJC, CW.

  • Funding MTS is supported by an NHMRC Early Career Fellowship. CXW is supported by a Mid-Career Fellowship from the Hospital Research Foundation and a Postdoctoral Fellowship from the National Heart Foundation of Australia and the University of Adelaide.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Data accessed via Australian Institute of Health, Welfare and Ageing website. The data includes all procedures (defined as a clinical intervention that is surgical in nature) performed in Australian public and private hospitals and the data are freely available online via the Australian Institute of Health and Welfare website: There are no conditions regarding reuse.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.