Abstract
Purpose:
To evaluate the complexity of physician visits, diagnostic testing and financial burden for patients in the evaluation of non-organic visual loss. Evaluation of non-organic visual loss (NOVL) can be extensive and costly. Patients with NOVL often visit multiple physicians and undergo repeat testing in the exploration of their visual complaints. A study analyzing intricacy of diagnostic testing, physician visits and medical cost for a patient with NOVL has not been documented.
Methods:
During Mar-Apr 2013, 10 new patients (representing 10% of new patients in this period) presented for initial ophthalmic examination and received a diagnosis of NOVL. Each patient saw ≥ 1 physicians for the same visual issue prior to neuro-ophthalmic exam. Patients underwent an eye exam and some combination of: MRI brain w/wo contrast, CT Head w/wo contrast, OCT retinal nerve fiber layer (RNFL), automated perimetry, kinetic perimetry, lumbar puncture, visually evoked response and electroretinography. Average cost of each test based on CPT code and out-of-pocket expense was provided by Baylor College of Medicine, Houston, TX. Cost analysis of total number of physician visits and diagnostic testing was assessed per patient. Correlation coefficients were calculated with significance at p < 0.05.
Results:
Mean patient age was 37 ± 17 (SD) (range 17-77). All patients were female. For the same visual complaint, 50% of patients saw 2 physicians, 40% saw 3 physicians and 10% saw 4 physicians. An ophthalmologist and neurologist were seen by 70% of patients. Initial exam was ≥ 45 minutes in 80% of patients, 63% of whom required ≥ 80 minutes. Mean cost per patient for NOVL evaluation was $4099.60 ± $1822.62 (SD) (range $1242-$6150). There was a strong correlation between number of physicians seen and total cost per patient (R=0.76, R2=0.58, p=0.0054). The most costly test was MRI brain; 30% of patients received ≥ 1 MRI for the same issue. 20% of patients did not proceed with imaging despite recommendation; these patients incurred the lowest total cost ($1242). The least costly tests, OCT RNFL and automated perimetry were performed for all 10 patients. Of these patients, 5 underwent additional kinetic perimetry at the same visit.
Conclusions:
Evaluation for nonorganic visual loss is complex and expensive. Many diagnostic tests are performed because of concern for an organic cause of visual loss and multiple physicians are often involved.
Keywords: 759 visual impairment: neuro-ophthalmological disease •
612 neuro-ophthalmology: diagnosis