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Eric Schneider, Prithvi Mruthyunjaya, Nidhi Talwar, Kristen Harris Nwanyanwu, Bin Nan, Joshua Stein; Trends in Utilization of Ancillary Testing for Patients with Exudative Macular Degeneration and Macular Edema from 2001 to 2009. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4418.
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© ARVO (1962-2015); The Authors (2016-present)
To assess trends in the use of ancillary diagnostic imaging in patients with exudative age-related macular degeneration (AMD) and macular edema (ME) over the past decade.
Claims data from a large nationwide managed-care network were analyzed to assess trends in the use of fluorescein angiography (FA), fundus photography (FP), and other ocular imaging (OOI) for beneficiaries with a diagnosis of exudative AMD (n= 22,954) or ME (n= 31,810) in 2001-2009. Repeated measures multivariable logistic regression was performed to compare the odds of undergoing each of these procedures in 2001, 2005, and 2009. Next, enrollees with an incident diagnosis of exudative AMD or ME in 2003 (n= 1,023 for AMD; n= 1,090 for ME) and 2008 (n=1,258 for AMD; n= 2,616 for ME) were compared to determine changes in the proportion who received FA, FP, and OOI.
The proportion of enrollees undergoing OOI—for which optical coherence tomography represents >90% of all claims—within 1 year following initial diagnosis of exudative AMD and ME increased 53.9% and 44.2%, respectively, from 2003 to 2008. By comparison, significant decreases were noted (7.9-11.5%) in the usage of FA and FP in the 2008 cohort relative to the 2003 cohort. The use of OOI without FA within 1 year following initial diagnosis of exudative AMD and ME increased 19.0% and 27.9%, respectively, from 2003 to the 2008. For beneficiaries with exudative AMD, the odds of undergoing OOI increased 24-fold from 2001 to 2009. In contrast, the odds of undergoing FA and FP testing for exudative AMD decreased 68% and 79%, respectively, during this time period. Trends for ME were similar to those for exudative AMD.
Utilization of OOI for AMD and ME increased dramatically over the study period. This corresponded with a smaller, but significant, decrease in FA and FP use, suggesting that OOI is replacing more traditional diagnostic testing. As current treatment paradigms are based on historic treatment trials that have utilized FA with or without OCT to define treatable disease, further studies are needed to assess if increased reliance by eye care providers on OOI in lieu of FA and FP impacts patient outcomes.
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