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J. D. Stein, F. A. Sloan, P. P. Lee; Rates of Glaucoma Medication Utilization Among Persons With Primary Open Angle Glaucoma, 1992-2002: Findings From the Medicare Current Beneficiaries Survey. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1559.
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To characterize the usage of therapy for primary open angle glaucoma (POAG) among a nationally representative sample of Americans 65 and older followed over time.
Data analysis of the Medicare Current Beneficiary Survey (MCBS) was undertaken for the years 1992 to 2002. The MCBS is a survey of Medicare beneficiaries that uses face-to-face interviews to determine the type and dosage of each glaucoma medication used in the preceding year by each beneficiary. By using MCBS data merged with Medicare claims, rates of medical and surgical treatment for individuals aged 65 years and older with POAG were determined. Trends in utilization by glaucoma medication class were identified over the eleven year period.
The MCBS contained utilization data for 3,020 beneficiaries (7,965 person-years) with POAG. During each year of the study period, approximately 30% of beneficiaries with POAG were untreated medically or surgically. Over the study period, the use of ß-blockers and miotics decreased considerably. In comparison, utilization rates increased substantially for a-agonists, combination ß-blockers - carbonic anhydrase inhibitors, and prostaglandin analogues.
In this nationally-representative study using patient-reported and interviewer verified data to determine glaucoma medication utilization rates for elderly Americans with POAG linked with claims data for prior surgery, almost 1/3 of older Americans with diagnosed POAG are not under therapy. Despite both the availability of more efficacious classes of glaucoma medications with few side effects and the findings of clinical trials underscoring the importance of intraocular pressure reduction in POAG patients, many patients with POAG continue to go untreated. It is of critical importance that clinicians and health-policymakers implement ways of improving treatment among elderly Americans with POAG.
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