June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Visual field testing, 15 year trends in a large health maintenance organization
Author Affiliations & Notes
  • Elad Ben-Artsi
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
  • Asaf Cohen
    Maccabi Healthcare Services, Tel Aviv, Israel
  • Avi Porath
    Maccabi Healthcare Services, Tel Aviv, Israel
  • Modi Goldenfeld
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
    Maccabi Healthcare Services, Tel Aviv, Israel
  • Hani Levkovitch-Verbin
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
    Maccabi Healthcare Services, Tel Aviv, Israel
  • Footnotes
    Commercial Relationships   Elad Ben-Artsi, None; Asaf Cohen, None; Avi Porath, None; Modi Goldenfeld, None; Hani Levkovitch-Verbin, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3733. doi:
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    • Get Citation

      Elad Ben-Artsi, Asaf Cohen, Avi Porath, Modi Goldenfeld, Hani Levkovitch-Verbin; Visual field testing, 15 year trends in a large health maintenance organization. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3733.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Visual field (VF) testing is a fundamental testing modality in ophthalmology and particularly in diagnosis and follow up of glaucoma patients. We performed a retrospective cohort study to identify VF testing trends over the past 15 years in a large healthcare organization.

Methods : The eligible study population consisted of all Maccabi Healthcare Services members between January 2000 and December 2014. We performed statistical analysis of our longitudinal electronic medical charts. Approximately 2 million patients were analyzed with regard to presence of glaucoma or glaucoma suspect diagnoses, registered antiglaucoma medications and number of VF tests performed.

Results : Between the years 2000-2014, 198,864 VF tests were performed by 93,637 patients. Of all VF tests, 47.5% were not related to patients with any glaucoma/ glaucoma suspect diagnosis nor to patients who received antiglaucoma medications. This fraction demonstrated an increasing trend and in 2014, 74% of all tests were as such. Among glaucoma patients, normal tension glaucoma patients performed the highest number of tests with a mean (±SD) of 3.5±3.4 VF per patient. Pigmentary dispersion, pseudoexfoliation and open angle glaucoma patients performed more tests than others with means of 3.2±3.2, 2.7±3.1 and 2.6±3.1 VF per patient respectively. The mean time interval between first glaucoma related diagnosis to first VF was 26.5±6.3 months. Once a patient performed his first VF, the annual mean of VF performed was 1.0±0.4. In most Israeli regions the average numbers of annual VF tests ranged between 0.9+0.4 to 1.1±0.5 tests per patient. In the peripheral northern region only 0.4±0.2 annual tests were performed per patient.

Conclusions : There is a growing trend of VF tests performed on indications other than glaucoma. Approximately half of the patients were sent to VF tests due to headaches, unspecified visual disturbances, neurologic or neuro-ophthalmologic suspected conditions. On average, suspected glaucoma and glaucoma patients were sent to their first VF test more than 2 years after diagnosis. This relatively long primary interval is opposed to an average once-a-year VF assessment that begins after the first VF test was performed. A possible explanation is that only after a VF damage is demonstrated, do ophthalmologists tend to monitor its progression. Regional differences in access to VF tests affect annual performances.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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