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Irma Muminovic, Won Yeol Ryu, Scott R Lambert; Frequency of office based probing for treatment of nasolacrimal duct obstruction. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3134. doi: https://doi.org/.
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Nasolacrimal duct obstruction (NLDO) is a common disorder in young children and most cases resolve spontaneously. In cases that do not resolve spontaneously, treatment options include probing in an office setting using topical anesthesia or a facility using general anesthesia. The Pediatric Eye Disease Investigators Group (PEDIG) conducted a randomized controlled trial (Nasolacrimal Duct 3 (NLD3) study) that found a high success rate with office probings and increased cost effectiveness. We hypothesized that after the publication of the findings of the NLD3 study in December 2012 that there would be an increase in the frequency of office probings in the United States.
Using the Optum dataset we identified all children < 2 years of age with the diagnosis of NLDO. Patients who underwent treatment for NLDO were identified using the CPT codes for office probing, facility probing, facility probing with insertion of stent, or facility balloon catheter dilation. We compared the number of patients that underwent office probing between the years 2010-2011 and 2013-2014.
We identified 156,044 children with the diagnosis of NLDO in the database. A total of 4,078 procedures were performed on this cohort which included 843 (20.7%) office probings, 2,196 (53.8%) facility probings, 653 (16%) facility stent intubations, and 386 (9.5%) facility balloon catheter dilation. The majority of patients (44.3%) underwent office probing between the ages of 12-18 months followed by 18-24 months of age (23%). We identified 462 office probings that were performed between years 2010 and 2011 and 381 office probings between years 2013 to 2014. The difference in number of procedures preformed between the two time periods was statitically significant (p=0.007).
The majority of NLD treatments are performed in facilities. Despite comparable treatment success to facility probing, the practice of office probing had not increased in the two years following the publishing of the PEDIG study.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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