Practice Patterns and Technology Readiness for Sulcus Tube Placement: A Survey of the American Glaucoma Society Membership

Anya Rahman,1,* Jordan Whitney,1,* Nadine Abdeljabbar,1 Aaron D Webel1,2 1University of Missouri - Columbia School of Medicine, Columbia, MO, USA; 2Department of Ophthalmology, University of Missouri - Columbia, Columbia, MO, USA*These authors contributed equally to this workCorrespondence: Aaron D Webel, Department of Ophthalmology, University of Missouri – Columbia, 3215 Wingate Ct Ste 102, Columbia, MO, 65201, USA, Tel +1 (573) 884-3937, Email adw881@health.missouri.eduPurpose: To evaluate glaucoma surgeons’ practice patterns regarding glaucoma drainage device (GDD) tube shunt placement, assess their opinions on sulcus tube placement, and evaluate their receptiveness to technologies designed to improve sulcus tube placement.Patients and Methods: A 12-question survey was distributed electronically to American Glaucoma Society (AGS) members between November 6 and December 23, 2024. The survey assessed surgeons’ current tube-shunt placement practice patterns, factors influencing tube placement decisions, and receptiveness to proposed technologies designed for sulcus tube placement. Descriptive analysis was performed on 121 completed responses.Results: Most respondents (55%) reported a preference for placing tubes in the anterior chamber (AC) for the majority of their pseudophakic patients, with efficiency (62%), safety (62%), and familiarity (57%) reported as primary factors for this decision. Barriers to sulcus placement included concern for intraocular bleeding (67%), technical difficulty of sulcus placement (54%), the risk of vitreous loss and tube occlusion (53%), and iris complications (53%). However, if a sulcus tube insertion technology was available and assuming a randomized controlled trial (RCT) demonstrated the superiority of sulcus over AC placement in minimizing endothelial cell loss (ECL), 85% of respondents indicated they would be likely to routinely place tubes in the sulcus. Features deemed very important for such a technology included tube placement accuracy (87%), ...