PURPOSE: To evaluate racial and ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with a diagnosis of mild or moderate POAG, as defined by Current Procedural Terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients, and the control group consisted of patients without an AA designation in the TriNetX database. METHODS: Propensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, body mass index, and weight. Outcome was incidence of MIGS over 1 year of follow-up. Odds ratios were calculated between cohorts. MAIN OUTCOME MEASURE: Incidence of MIGS over 1 year of follow-up post-POAG diagnosis. RESULTS: A total of 63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared with non-AA patients (1,508 of 31,709) (odds ratio 0.834, 95% CI 0.773-0.900). CONCLUSION: Although POAG is understood to be more prevalent among African Americans, these patients display lower use of MIGS, suggesting a possible nationwide racial disparity in the management of POAG.