Referral for first glaucoma surgery in Europe, the ReF-GS study

Gabor Hollo*, Doreen Schmidl, Anton Hommer, I. Stalmans, T. Daphne, M. Fichtl, E. Ruzickova, L. Rezkova, A. M. Bron, E. M. Hoffmann, A. Klezlova, C. Erb, N. Zimmermann, P. Kothy, A. Gandolfi, L. Varano, N. Ungaro, Januleviciene, L. Kuzmiene, H. J. M. BeckersGrabska-Liberek, J. Majszyk-Ionescu, A. Skowyra, A. Plichta, Alina Popa-Cherecheanu, Dorin Chiselita, A. Brezhnev, A. Baranov, N. Babic, A. Miljkovic, S. L. Ferkova, B. Cvenkel, Julian Garcia-Feijoo, Ruben Sanchez Jean, Botling A. Taube, M. Irkec, S. Kocabeyoglu, C. Vass, ReF-GS Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Purpose: To analyze the appropriateness of referrals for incisional glaucoma-surgery in Europe. Methods: Referrals for the first open-angle glaucoma surgery between January and October 2017 were analyzed in 18 countries: 8 "old" European Union, 7 "new" European Union and 3 non-European Union European countries. Results: Most eyes had primary open-angle or exfoliative glaucoma. The average mean deviation was -13.8 dB with split fixation in 44.3%. No structural progression analysis was made before the referrals. The most common medications were the combination of a prostaglandin analog, timolol and a carbonic anhydrase inhibitor (30.0%), and all other combinations comprising > 3 molecules (33.8%). Laser trabeculoplasty was reported in only 18.4%. Of the 294 referrals, 41.5% were appropriate and timely, 35.0% appropriate but later than optimal, and 17.6% appropriate but too late (minimal vision maintained). The treatment period was significantly longer (median: 7 years) in the "old" European Union countries than in the other groups (3 and 2 years, respectively). No between-group differences were seen in intraocular pressure and mean deviation, but the non-European Union group referred the patients at significantly lower cup/disk ratio and eye drop usage than the other groups. Split fixation was significantly more common in the "old" (60.6%) than the "new" European Union countries (38.7%), and in both EU country-groups than in the non-European Union countries (13.6%). Conclusions: Of 294 European open-angle glaucoma referrals for first glaucoma-surgery, 41.5% were completely satisfactory. The damage was typically advanced, and the care varied considerably among the countries. This suggests that further efforts are necessary to improve glaucoma care in Europe.

Original languageEnglish
Pages (from-to)406-416
Number of pages11
JournalEuropean Journal of Ophthalmology
Issue number4
Publication statusPublished - Jul 2019


  • Blindness
  • Europe
  • European Union
  • glaucoma surgery
  • referral
  • therapy

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