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G. Reardon, E. Mozaffari; Declining Rates of Glaucoma Surgeries in a Managed Care Population: 1996 to 2001 . Invest. Ophthalmol. Vis. Sci. 2003;44(13):170.
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Purpose: The numbers of glaucoma-related surgeries in Medicare patients reportedly have declined during the past several years. This study measured annual rates of trabeculectomy (TRAB) and argon laser trabeculoplasty (ALT) in a broader managed care population to determine if the decline in surgery is limited to Medicare patients. Methods: This retrospective, cohort study used Protocare Sciences Proprietary Longitudinal Database that includes approximately 3 million insured members in commercial HMOs and PPOs as well as Medicare-risk plans. The primary outcomes were rates of TRAB and ALT performed over 5 years (1996 to 2001) based on paid medical claims for patients 45 years and older who were receiving glaucoma pharmacotherapy (n=90,542). The time period at risk for surgery was estimated from the date of the earliest observed prescription fill for a topical ocular hypotensive drug until either 1) end of continuous enrollment, 2) end of the study period (12/31/2001), or 3) date of the first TRAB or ALT. Poisson regression was used to evaluate how rates changed over time after adjusting for age and sex. Results: Surgery rates declined between 1996 and 2001 at an estimated adjusted annual rate of 18% for TRAB and 17% for ALT. TRAB rates in patients <65 and >64 were 11.5 versus 11.4, respectively, per 1,000 patient years in 1996 and were 6.0 versus 3.5, respectively, per 1,000 patient years in 2001. Across all ages, the adjusted rate for TRAB in 2001 was 34% of the rate found in 1996 (95% CI, 27% to 42%). For ALT, the age-specific decline was similar but more gradual. Across all ages, the overall 2001 ALT adjusted rate was 43% of the 1996 rate (95% CI, 37% to 51%). Conclusions: These results from a mixed-model managed care plan confirm previously reported findings for Medicare patients and demonstrate that glaucoma-related surgery has declined rapidly among younger patients (45 to 64 years) as well. These declines may be attributable in part to recent advances in glaucoma pharmacotherapy.
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