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Joseph F. Griffith, Jeffrey L. Goldberg; The Frequency of Optical Coherence Tomography Testing in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):663.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography (OCT) is a newer imaging test that measures the thickness of and anatomic relationships between retinal layers. Ophthalmologists lack guidelines on how frequently glaucoma patients should undergo OCT examinations, in contrast to visual field (VF) testing. This study compares the frequency of OCT examinations to clinic visits and VF tests in patients with five common types of glaucoma.
A retrospective chart review at an academic medical center used billing records from 2003-2010 for patients age 40 and above with primary open angle, low tension open-angle, pigmentary open-angle, chronic angle-closure, and pseudoexfoliation glaucomas. Patients were included if they had the same diagnosis associated with at least three clinic visits during at least two years. Patients were included in VF or OCT calculations if they had at least four of the respective test.
6100 patients met study criteria. Mean OCT frequency was 2.26 OCTs/year (N=983, SD=2.47). No difference in OCT frequency between glaucoma types was detected (range 2.14-2.59/year, P=0.82). The mean visit frequency was 2.77 visits/year (N=6101, SD=1.35). The difference in visit frequency between glaucoma types was not statistically significant (range 2.32-2.80, P=.055). Mean VF frequency was 1.38 tests/year (N=3937, SD=0.57). VF frequency was higher for low tension open-angle glaucoma (1.53/year) than the other glaucomas (range 1.22-1.39/year, P<.001). The difference in the VF frequency was statistically significant (P<.05, Bonferroni post-hoc t-test) between all glaucoma types except for pigmentary open-angle glaucoma and between chronic angle-closure and pseudoexfoliation glaucomas. OCT, VF, and visit frequencies were different within each glaucoma diagnosis (p<.05, Bonferroni post-hoc t-test) except for pigmentary open angle and pseudoexfoliation glaucomas. Pigmentary open angle glaucoma frequencies were only different between visit and VF tests (P<.001). Pseudoexfoliation glaucoma frequencies were not statistically significant between visit and OCT frequencies (P=.83).
Differences between OCT, VF testing, and visit frequency in different glaucomas may reflect acuity or severity of disease. Validation of the clinical impact of variable testing rates should be undertaken.
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