Abstract
Purpose:
To evaluate how procedural treatments for glaucoma have changed between 1995 and 2011.
Methods:
Medicare fee-for-service data claims between 1995-2011 were analyzed to determine the number of penetrating surgeries and laser procedures performed for glaucoma in the Medicare population for each calendar year.
Results:
Trabeculectomies in eyes without previous scarring decreased 50% from 51,690 in 1995 to 25,758 in 2003, and dropped a further 49% to 13,077 in 2011. Trabeculectomies in eyes with scarring ranged between 10,366 and 13,604 between 1995-2003, but then decreased 44% from 11,018 to 6,117 from 2003-11. The number of aqueous shunting devices placed rose 185% from 2,728 in 1995 to 7,788 in 2003, and increased a further 43% to 11,111 in 2011. Total cytophotocoagulation procedures increased 179% from 3,264 in 1995 to 9,106 in 2003, and increased a further 50% to 13,657 in 2011. The number of transscleral cytophotocoagulations decreased 46% from 5,978 to 3,231 between 2005-11; concurrently, the number of endoscopic cytophotocoagulations increased 94% from 5,383 to 10,426 between 2005-11. The number of laser trabeculoplasties decreased 57%, from a high of 151,244 in 1995 to a low of 75,647 in 2001. From 2001-05, the number of trabeculoplasties more than doubled (176,476 in 2005), but since then the number of trabeculoplasties has decreased 16% (148,052 in 2011). The number of laser iridotomies has stayed fairly consistent between 1995-2011, increasing 14% over this period and ranging from 63,701 to 85,426. Canaloplasties increased 858% from 161 in 2007 to 1,543 in 2011, while express shunts increased 113% from 2,718 in 2009 to 5,788 in 2011.
Conclusions:
Glaucoma procedures demonstrating a significant overall increase in volume in recent years include canaloplasty, express shunt implantation, aqueous drainage device surgery, and endoscopic cyclophotocoagulation. Trabeculectomy numbers show a continued long-term downward trend in utilization. After a decline in use between 1995-2001, laser trabeculoplasty increased more than twofold from 2001-05, but has since declined again marginally. The continued movement away from trabeculectomy and towards other IOP-lowering procedures highlights the need for clinical trials comparing the efficacy of these procedures.
Keywords: 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials •
460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower •
568 intraocular pressure