Background: Stent-based MIGS (sb-MIGS) is a revolutionary technology that allows patients to receive sight-saving procedures in a safer and less invasive way. The utilization of sb-MIGS nationally has yet to be explored. Epic Cosmos is a dataset made up of 260-million patients who receive care at a healthcare institution that uses Epic as their electronic health record system. While Sb-MIGS has become popular over the last 10 years, there has been limited published data focused on demographic variations, making our study the first to investigate this topic.

Method: The proportion of patients with a diagnosis of mild or moderate primary open-angle glaucoma (mm-POAG), ICD-10 code H40.11X, was compared to the proportion of patients who underwent sb-MIGS, CPT code 0191T denoting iStent or Hydrus implantation, between 1/2014 - 12/2023.

Results: 19149 patients received sb-MIGS out of 361830 mm-POAG patients. Most mm-POAG patients resided in urban areas (90.3% urban vs 6.5% rural; p<0.01). Most sb-MIGS were performed in urban areas (86.4% vs 9.7%; p<0.01). These splits are somewhat different from the urban/rural population split (80/20) per the 2020 US census. A higher proportion of rural patients underwent sb-MIGS relative to mm-POAG rates (~5/100 rural patients vs ~3/100 urban patients; p<0.01), which coincided with an odds ratio of 26.0. Rural non-Hispanic whites (NHW) (90.9% sb-MIGS vs 90% mm-POAG; p=0.34) and minorities, composed of Black-Americans, American-Indian and Hispanic patients, (9.1% vs 9.2%; p=0.88) received sb-MIGS at rates similar to mm-POAG diagnoses rates. Urban NHWs received sb-MIGS at rates significantly higher than mm-POAG diagnosis rates (73.8% vs 63.4%; p<0.01). Urban minorities received sb-MIGS at considerably lower rates versus mm-POAG diagnosis rates (10.9% vs 37.6%; p<0.01). The Epic customer profile limits this study.

Conclusions: Our findings suggest that mm-POAG diagnoses and sb-MIGS rates are significantly higher in urban areas, where racial and ethnic barriers to sb-MIGS appear to be exacerbated. While geographic barriers may limit rural communities from getting access to eye care, ethnic and racial barriers may not be as limiting.