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Karun Arora, Alan L Robin, Kevin Corcoran, Suzanne Corcoran, Pradeep Y Ramulu; Utilization of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1995 to 2011. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4315.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate how procedural treatments for glaucoma have changed between 1995 and 2011.
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.
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.
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.
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