PROVIDENCE, RI — Laser trabeculoplasty (LTP) is the use of a laser beam to burn areas of the trabecular meshwork, located near the base of the iris, to increase fluid outflow. LTP is used in the treatment of various open-angle glaucomas, and acceptance of the procedure as first-line therapy appears to be growing at the VHA.

That’s according to a survey initiated because, according to Providence VAMC-led researchers, surgical practice patterns have not been well described in the United States. Their study, published in Military Medicine, sought to evaluate the indications for and potential barriers to glaucoma surgery in the VHA.1

Researchers sent by mail with a web link an anonymous 10-question survey using REDCap (Nashville, TN) software to ophthalmology chiefs at the 86 academically affiliated VAMCs. The team selected academic-affiliated VAMCs because of their patient range and role in ophthalmic education.

Nonresponders received two reminder emails and two phone calls, with the survey closed after six weeks. The response rate was 45% (39/86). Most respondents (92%) worked in an integrated eye clinic with both ophthalmology and optometry services, according to the researchers.

According to their responses, nearly half of the respondents (49%; 19/39) believed that laser trabeculoplasty (LTP) was an option for initial glaucoma therapy. Noncompliance with medications was a commonly reported indication for LTP (95%), tube shunt procedures (65%), micro-invasive glaucoma surgery (59%) and trabeculectomy (48.7%).

In addition, a third of the respondents believed that there were delays in glaucoma care at their facilities. The survey-takers also noted that significant barriers in access to surgery included lack of transportation (69%), scheduling challenges (62%) and delayed referral (62%).

“This survey of glaucoma surgery practice patterns highlights the growing role of LTP and suggests that non-compliance and access remain significant barriers to glaucoma surgical care within the VHA,” the authors concluded.


  1. Olivieri DJ, Lynch MG, Cockerham GC, Greenberg PB. A Survey of Glaucoma Surgery Practice Patterns in the Veterans Health Administration. Mil Med. 2020 Aug 14;185(7-8):e972-e976. doi: 10.1093/milmed/usaa033. PMID: 32412083.