The Relationship of Frailty with Surgical and Laser Treatment for Patients with Glaucoma

Jonathan D Groothoff,1 James A Rhead,1 Isaiah J Miller,1 Nicholas D De la Osa,1 Jordan A Perry,1 Walter S Duy,1 Joni K Evans,2 Atalie C Thompson1,3 1Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 2Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 3Division of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USACorrespondence: Atalie C Thompson, Department of Ophthalmology, Division of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27517, USA, Email [email protected]: The purpose of this study was to determine whether frailty, quantified by an electronic Frailty Index (eFI), was associated with the likelihood of receiving surgery or laser treatment in patients with glaucoma.Methods: Single-center retrospective review of patients presenting with glaucoma who had a calculable eFI. A repeated measures multivariable logistic regression model was used to determine the relationship between eFI score and the likelihood of having glaucoma surgery, and a multivariable survival model was also created to assess time to glaucoma surgery. Similar models were constructed for laser treatment (LT). Models were adjusted for age, race/ethnicity, sex, baseline intraocular pressure, and severity based on mean deviation.Results: A total of 1168 patients (2248 eyes) were included in this study. Glaucoma surgery was significantly more likely among those with severe [OR=2.89] or moderate glaucoma [OR=1.89] (p< 0.001). Older age (per 10 year increase) was associated with a significantly lower likelihood of receiving glaucoma surgery [OR=0.581, p< 0.001], longer times to glaucoma surgery [HR=0.719, p=0.007], and lower likelihood of LT [OR=0.774, p=0.05]. For every 0.1 unit increase in eFI, indicating greater frailty, there was a significantly reduced likelihood of receiving surgical treatment [OR=0.672, p< 0.001], longer time to surgery [HR=0.670, p=0.001], and lower likelihood of LT [OR=0.725, p=0.010], independent of IOP, glaucoma severity, age, sex, or race.Conclusion: Increased age and frailty scores are associated with reduced likelihood of receiving glaucoma surgery or LT and longer time to glaucoma surgery, even after controlling for baseline IOP and glaucoma severity. Future studies should investigate whether frailty impacts surgical outcomes in glaucoma.Keywords: frailty, electronic frailty index, glaucoma surgery