Trends in First-Line Glaucoma Treatment from 2013 to 2024: A Multi-institutional and Multinational Cohort Study

Introduction: Glaucoma remains a leading cause of adult blindness worldwide, highlighting the need for updated insights into contemporary first-line treatment patterns. Methods: We conducted a retrospective cohort study using electronic health records from the TriNetX Global Collaborative Network (2013–2024). Patients aged ≥ 40 years with a diagnosis of open-angle glaucoma (OAG) or angle-closure glaucoma (ACG) were included. Monotonic trends in first-line glaucoma treatment were assessed over 12 years using Mann–Kendall tests, with Kendall’s τ and a false discovery rate-adjusted P value (the Q value) reported. A positive τ indicated an increasing trend and a negative τ a decreasing trend. First-line treatments were classified into three categories: medication (single or combination therapy), surgery, and laser therapy. Results: We included 322,910 patients with OAG and 40,119 patients with ACG. In OAG, the use of medication as initial therapy declined over time (91.0% in 2013, 87.7% in 2018, and 85.8% in 2024; τ = − 0.515, Q = 0.036), whereas surgery increased (4.8%, 7.9%, and 9.0%, respectively; τ = 0.606, Q = 0.021), and laser treatment remained stable (4.2%, 4.5%, and 5.2%; τ = 0.303, Q = 0.193). In ACG, medication use increased (72.4%, 79.3%, and 88.6%; τ = 0.818, Q < 0.001), while both surgery (9.8%, 5.3%, and 2.6%; τ = − 0.879, Q < 0.001) and laser therapy (17.8%, 15.4%, and 8.8%; τ = − 0.788, Q < 0.001) declined. Conclusions: Medication therapy accounted for most first-line treatment in both OAG and ACG between 2013 and 2024. Over time, treatment patterns shifted toward greater use of surgery in OAG and increased reliance on medication in ACG. These trends highlight the need for future studies to evaluate long-term outcomes and inform subtype-specific glaucoma care.