To assess practice patterns and opinions of glaucoma specialists regarding indications, surgical technique, and post-operative management for non-valved aqueous shunts.
Anonymous online survey study PARTICIPANTS: American Glaucoma Society (AGS) members METHODS: An anonymous online survey was distributed to glaucoma specialists via the AGS forum from June to August 2022.
Survey questions and responses were assessed in four sections: (1) general demographics and practice patterns, (2) non-valved tubes vs. trabeculectomy, (3) non-valved tubes vs. valved tubes, and (4) non-valved tube techniques.
There were 132 respondents; non-valved tubes were reported to be performed more often than trabeculectomy by 61% of respondents within 5 years of completing training and 23% of respondents with more than 15 years since completing training. The most frequently preferred types of non-valved tubes were Baerveldt-350 (41%), Baerveldt-250 (27%), and ClearPath-250 (18%). In patients with lower target IOP, 92% of respondents preferred trabeculectomy over non-valved tube; 33% cited a cutoff of <12 mmHg, and 31% cited a cutoff of 40 mmHg, and 38% cited a cutoff of >30 mmHg. The most frequently used ligature was 7-0 Vicryl (69%). The most frequently used strategies for early IOP lowering were fenestrations without wicks (70%) and with wicks (22%), with one 10-0 Nylon being the most used wick technique (22%). Overall, 37% of respondents use a ripcord; among ripcord users, 55% use it for hypotony prevention (3-0 Prolene most common for this purpose at 35%), and 40% use it for optional early IOP lowering (4-0 Nylon most common for this purpose at 21%). If IOP is too high at postoperative week 4, 38% of respondents do not open the tube early.
We demonstrate significant heterogeneity regarding specific indications, surgical technique, and postoperative management for non-valved tubes. Future work is needed to identify and develop standardized guidelines alongside best practices.

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