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Rachel E. Williams, Mathew Beeby, John Logie; Prevalence Of Diagnosed Macular Hole, Macular Pucker, Vitreomacular Adhesions/Traction, Retinal Tear/Detachment, and Pterygium In US Health Care Claims Databases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5221.
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There is limited information on prevalence of diagnosed eye conditions using insurance claims databases in the United States, hence we evaluated several conditions.
We evaluated the prevalence of macular hole, macular pucker, and vitreomacular adhesions/traction (VMA/VMT) in the Optum™ Impact™ National Managed Care Benchmark Database (OptumInsight, Eden Prairie, MN) in 2009. Disease was defined by appropriate ICD-9 codes. The denominator was determined by people with health care coverage during 2009. Prevalence of diagnosed disease during the year was determined by the % of people that had a diagnosis during 2009. Incidence was calculated as the % of newly diagnosed cases in 2009; patients had no prior diagnosis. We also evaluated the prevalence of pterygium using SÆfetyWorks®, a database analysis tool, with the Thompson Reuters Medicare (MDCR), Medicaid (MDCD), and Commercial databases (CCMC). We defined the denominator as those with health care coverage in 2009 and at least one insurance claim in their history. Pterygium was defined by ICD-9 codes. Prevalence was determined by percent of people with diagnosis in 2009.
In 2009, prevalence (%) of macular hole was 0.11, macular pucker was 0.27, VMA/VMT was 1.02, and retinal tear/detach was 0.26 (Table 1). Pterygium prevalence (%) was 0.08, 0.05, 0.17 and recurrent pterygium was 0.002, 0.001, 0.003 in the CCMC, MDCD, and MDCR databases, respectively
This is a study of eye conditions using US insurance claims databases, to determine the percent of the insured population that received a diagnosis in 2009. These estimates may be lower than the overall prevalence of disease, as patients needed to seek care, get diagnosed and have a claim submitted. It provides us with information about the percent of the insured population seeking care in a given year for these conditions.
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