IRIS Registry contrasts pigmentary vs POAG
- A new IRIS Registry analysis compared pigmentary glaucoma with primary open-angle glaucoma and found they do not follow the same surgical pathway in U.S. practice. (sciencedirect.com) - The dataset comes from the AAO’s IRIS Registry, which aggregates EHR data from 3,000-plus practices and more than 300 million patient visits. (aao.org) - That matters because MIGS-era glaucoma care is increasingly diagnosis-specific, so training and expectations built around generic “open-angle glaucoma” can miss real differences. (advances.massgeneral.org)
Glaucoma surgery is no longer one bucket. That is basically the point of this new IRIS Registry analysis comparing pigmentary glaucoma with primary open-angle glaucoma. Both a(sciencedirect.com)y asks a simple, useful question — do they actually get operated on the same way, and do they do equally well after surgery? The answer appears to be no. (sciencedirect.com) ### What are these two diseases, exactly? Primary open-angle glaucoma, or POAG, is the common baseline category — chronic optic nerve damage with an open angle and no secon(advances.massgeneral.org)used by pigment granules shedding from the iris and clogging the trabecular meshwork, which raises intraocular pressure through a more specific mechanical pathway. (eyewiki.org) ### Why compare them now? Because modern glaucoma surgery has fanned out. Surgeons now choose among trabeculectomy, tube shunts, and several MIGS options instead of one default operation. IRIS is usef(sciencedirect.com)outcomes tool is built from registry data spanning thousands of practices and hundreds of millions of visits. (aao.org) ### What changed with this paper? The new paper, published in *Ophthalmology*, specifically set out to compare the characteristics, surgery incidence, and surgical outcomes of pigmentary glaucoma versus POAG. That is more focused th(eyewiki.org)nstead of asking which glaucoma types got MIGS more often in general, this one drills into one secondary open-angle subtype and pits it directly against the biggest comparator group in practice. (sciencedirect.com) ### Why is pigmentary glaucoma the interesting test case? Because it sits awkwardly between categories. Coding-wise(aao.org) present as open-angle disease needing pressure reduction. The catch is that pigmentary glaucoma often affects younger, myopic patients and has a different outflow obstruction story, so a procedure that works well in the average POAG eye may not map perfectly onto this group. (aao.org) ### What does IRIS add that trials usually cannot? Scale and case(sciencedirect.com)y did across U.S. practice patterns. Prior IRIS-based surgery research has already shown that procedure choice varies strongly by glaucoma diagnosis, with open-angle and normal-tension eyes more likely to get iStent or CyPass, while secondary glaucomas more often receive standard surgery. This new comparison extends that logic to pigmentary glaucoma specifically. (advances.massgeneral.org) ### So what is the p(aao.org) or perform differently after trabeculectomy, tubes, or MIGS, that changes how surgeons should counsel patients and how programs should think about operative exposure. Residents may see plenty of POAG and still not have a good mental model for pigmentary cases. (sciencedirect.com) ### What can’t this study settle? Registry work is powerful, but it inherits coding noise, selection bias, and uneven follow-up. The Academy explicitly notes that IRIS o(advances.massgeneral.org)ormational and academic use, not as error-free ground truth. So the results are best read as a map of real-world patterns, not the final word on causality. (aao.org) ### Bottom line? The important shift is conceptual. Pigmentary glaucoma and POAG may share an open angle, but this analysis argues they should not be collapsed into one surgical story. (sciencedirect.com 1)(sciencedirect.com 2)
