Purpose: Evaluating trends in different glaucoma procedure utilization rates is critical for health policy planning. In Alberta, the frequency of micro-invasive glaucoma surgery (MIGS) and selective laser trabeculoplasty (SLT) have not been assessed relative to other glaucoma procedures. We aim to evaluate trends of glaucoma surgical and laser procedures performed in Alberta from 2003 to 2018. 

Study design: Retrospective, population-based analysis. 

Methods: The yearly number of glaucoma-related procedures claimed under the Alberta Health Care Insurance Plan from 2003 to 2018 were obtained using health service codes. Specifically, we considered the following procedures: trabeculectomy, glaucoma drainage device implantation, MIGS, laser trabeculoplasty, ciliary body ablation, surgical iridectomy, iridoplasty, and laser peripheral iridotomy. A primary open angle glaucoma (POAG) prevalence model was applied to age-stratified annual population data to estimate the number of Albertans with glaucoma each year. The yearly number of procedures per 1000 persons with POAG were then calculated. 

Results: From 2003 to 2018, the population in Alberta increased over 30% and the median age of Albertans increased by 1.6 years. The prevalence of glaucoma was estimated to increase from 0.51% to 0.60%. The number of ophthalmologists increased 23% from 88 to 108 during this time period. Correspondingly, rates of all glaucoma-related procedures increased 4-fold. Rates of glaucoma drainage device implantation increased 3-fold, with two peaks in 2011 and 2017. Procedures billed under “glaucoma (all major operations), except laser” fluctuated from 2003 to 2014 but remained overall stable. After separation of this code into ab-externo and ab-interno procedures in 2014, both trabeculectomy and MIGS rates increased over 60% from 2014 to 2018. Trabeculectomies and MIGS account for 41% and 34% of all glaucoma-related surgeries, respectively. Rates of repeat trabeculectomy within 28 days increased 4-fold from 2003 to 2009. “Anterior chamber laser” rates increased 6-fold from 2004 to 2014. After its separation into laser trabeculoplasty (LT) and laser peripheral iridotomy (LPI) in 2014, LTs increased 35% and LPIs increased 194% over the subsequent four years. Ciliary body ablation rates increased 19-fold from 2004 to 2018. 

Conclusions: In Alberta, trabeculectomy remains the most commonly performed glaucoma surgical procedure. However, a trend was noted towards increasing numbers of MIGS and ciliary body ablation procedures. MIGS has become the second most performed glaucoma surgical procedure. In contrast, laser trabeculoplasty rates have stabilized relative to other procedures in recent years.

Profile of glaucoma surgical and laser procedures in Alberta from 2003 to 2018

[Poster Abstract Booklet](https://drive.google.com/file/d/1AGitRGyG9W0FiZ2Xjz6RNO2h7C0XglOL/view)

[Surgical Video Abstract Booklet](https://drive.google.com/file/d/1B-IkojrZhXk4AgXzsEQyuE_FwPG1Lvpe/view?usp=sharing)

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