Study Links Air Pollution to Failed Glaucoma Surgery

California Medicare patients in high-pollution areas had higher risk of surgical failure.

Published on Mar. 5, 2026

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A study of California Medicare patients found that high levels of air pollution, particularly ground-level ozone, were associated with an increased risk of failure for incisional glaucoma surgery. The researchers analyzed data on 5,958 patients who underwent glaucoma procedures between 2016-2018, and found that each 10 ppb increase in ozone exposure was linked to a 27% higher risk of surgical failure.

Why it matters

This is one of the first studies to examine the impact of environmental factors like air pollution on glaucoma surgery outcomes. The findings suggest that a patient's local air quality may be an important consideration for glaucoma surgeons when evaluating treatment options and maximizing the chances of successful surgery.

The details

The study used Medicare claims data and air pollution measurements by zip code to analyze the relationship between exposure to ozone, nitrogen dioxide, and fine particulate matter, and the risk of glaucoma surgery failure. The researchers found that higher levels of all three pollutants were associated with increased failure rates, but only the link with ozone remained significant in a multi-pollutant analysis, with a 31% higher risk of failure for each 10 ppb increase in ozone exposure.

  • The study analyzed data on glaucoma surgeries performed between 2016-2018.
  • The air pollution data used was from 2015.

The players

Ken Kitayama, MD, PhD

A resident at the UCLA Stein Eye Institute who presented the study findings at the American Glaucoma Society 2026 Annual Meeting.

Cara Capitena Young, MD

A glaucoma specialist at the UCHealth Sue Anschutz-Rodgers Eye Center in Aurora, Colorado, who commented on the significance of the study.

Manjool Shah, MD

A glaucoma specialist at the W.K. Kellogg Eye Center at the University of Michigan in Ann Arbor, Michigan, who discussed how the findings could impact glaucoma treatment considerations.

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What they’re saying

“Our study provides population-based evidence that ambient oxidative air pollution, particularly ground-level ozone [O 3 ], may be associated with long-term risk of surgical failure after incisional glaucoma procedures.”

— Ken Kitayama, MD, PhD, Resident, UCLA Stein Eye Institute (Medscape Medical News)

“This is the first study to my knowledge to investigate this correlation. Drawing a correlation between failure of glaucoma surgery and specific environmental factors is hugely important.”

— Cara Capitena Young, MD, Glaucoma Specialist, UCHealth Sue Anschutz-Rodgers Eye Center (Medscape Medical News)

“As we have more and more nuance to our interventional toolkit, it stands to reason that we should certainly think about factors like a patient's environment.”

— Manjool Shah, MD, Glaucoma Specialist, W.K. Kellogg Eye Center, University of Michigan (Medscape Medical News)

What’s next

Further research would include replicating the findings in other populations and conducting mechanistic studies to explore how chronic oxidative exposure might influence subconjunctival fibrosis and glaucoma surgery outcomes.

The takeaway

This study highlights the potential impact of environmental factors like air pollution on the success of glaucoma surgery, suggesting that glaucoma surgeons may need to consider a patient's local air quality when evaluating treatment options and maximizing the chances of a successful procedure.