Abstract
Purpose :
To evaluate changes in glaucoma procedure utilization between 2002 and 2017.
Methods :
Medicare fee-for-service Part B Physician/Supplier data from the Part B National Summary Data Files were used to determine the number of glaucoma procedures performed on Medicare beneficiaries between 2002 and 2017.
Results :
Primary Trabulectomies (66170) deceased 58% from 40,251 in 2002 to 16,786 in 2017 while Secondary Trabeculectomies (661720) decreased a corresponding 59% from 15,432 in 2002 to 6,391 in 2017. Goniotomies (65820) averaged 70 per year from 2002 until 2006, then increased 140% to an average of 168 per year with the introduction of the Trabectome in 2006. With the introduction of the Kahook Dual Blade in 2015, goniotomies increased again 6,987% to 11,904 procedures in 2017. Canaloplasties (66174) increased from 399 in 2011 to 4,155 in 2017 (941%). Endoscopic Cyclophotocoagulation (ECP) (66711) rose from its introduction in 2005 and plateaued from 2009 to 2017, averaging 19,914 procedures annually. Transscleral Cyclophotocoagulation (TSCP) (66710) procedures increased 114% from 9,218 in 2002 to 19,762 in 2004. TSCP then showed a steady decline of 76% to a low a 4,745 in 2013 corresponding to an increase in use of ECP. Following the introduction of Micropulse TSCP in 2015, use of TSCP increased again to 18,409 in 2017. Laser Trabeculoplasty (65855) showed a steady increase of 70% from 109,143 in 2002 to 185,478 in 2017. Laser Iridotomy (66761) showed a modest increase of 22% from 76,161 in 2002 to 93,059 in 2017. The Xen Gel Stent (0449T) became available in 2017 with 2,539 procedures performed. The Cypass Micro-Stent (0474T) had 6,252 procedures performed in 2017, but has been removed from the market. Use of the ExPress Shunt (66183) declined 40% from 9,645 in 2014 to 5,778 in 2017. While use of the iStent and iStent inject (0191T) increased from 34 in 2010 to 84,454 in 2017.
Conclusions :
The total number of glaucoma procedures increased from 2002 to 2017. Trabeculectomies showed a steady decline in use over this period The number of laser procedures remained relatively constant since 2007. Minimally Invasive Glaucoma Surgeries (MIGS) showed a substantial increase since the introduction of these techniques and account for most the increase in procedures since 2007. These data show rapid adoption of newer, less invasive procedures and a continued decline in use of Trabeculectomy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.