Purpose 
Intravitreal anti-VEGF injections are a mainstay of treatment for a variety of common retinal conditions. Recent studies have shown individuals receiving anti-VEGF injections can experience sustained increases in intraocular pressure (IOP) and can subsequently develop a severe refractory form of glaucoma that often requires surgery. Previous reports in cohorts from British Columbia (BC) have suggested rates of glaucoma are substantial in anti-VEGF patients. To date, there is very little published data showing the rates of glaucoma in patients receiving anti-VEGF injections in BC versus other Canadian provinces.

Study design 
Quantitative survey 

Methods 
A survey was distributed through the Canadian Glaucoma Society to solicit members experiences with anti-VEGF related glaucoma. Participants were consented to have their anonymized responses as part of the survey. Fisher’s exact test was used to compare categorical variables whereas paired t-test was used for continuous variables.

Results 
We received responses from 43 glaucoma specialists from BC (n=11) and 6 other Canadian provinces (n=32). All (100%) BC specialists reported performing glaucoma surgery on patients receiving anti-VEGF who otherwise had no risk factors for glaucoma. This was a significantly (p=0.0186) larger proportion of specialists compared to the non-BC cohort (59%). Sixty-three percent of BC specialists reported performing a large (16 or more) number of surgeries per year for presumed anti-VEGF glaucoma. This was a significant increase (p<0.0001) compared to 0% of non-BC specialists reporting a similarly large number of surgeries. A substantial proportion (>40%) of non-BC specialists reported performing no surgeries for presumed anti-VEGF glaucoma, compared to none (0%) of the BC specialists reporting performing no surgeries. Nearly 30% of BC specialists reported seeing in their clinics a large (16 or more) number of patients per month with presumed anti-VEGF glaucoma. This is a significant increase (p=0.0134) compared to non-BC specialists, none (0%) of whom reported seeing a large volume. 

Conclusions
These data suggest glaucoma related to intravitreal anti-VEGF injections is more common in BC compared to other Canadian provinces. Management of patients previously receiving anti-VEGF injections seem to be an increasingly large part of a glaucoma specialist’s practice in BC. These results are limited by recall bias of participants and the voluntary nature of the survey. Future studies may directly quantify the prevalence and outcomes of glaucoma patients previously receiving anti-VEGF in BC and other Canadian provinces. Additional work can also elucidate any causal relationship that exists in BC between anti-VEGF and glaucoma.

Glaucoma and surgery rates in BC versus other Canadian provinces in patients receiving intravitreal anti-VEGF injections: A survey of Canadian glaucoma specialists

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