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Nikitha Reddy, Victoria Tseng, Fei Yu, Anne L Coleman; Predictors of Glaucoma Incisional and Laser Surgery in California. Invest. Ophthalmol. Vis. Sci. 2020;61(7):65.
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© ARVO (1962-2015); The Authors (2016-present)
We analyzed the distribution of glaucoma incisional and laser surgery in Medicare beneficiaries based on age.
A cross-sectional study was done using the 2015 Medicare claims databases from the Centers for Medicare and Medicaid Services. The inclusion criteria were those who lived in California in 2015 and 65+ years. The population included those with primary open angle glaucoma (POAG). The exposure of interest was age. The outcomes of interest were glaucoma surgery (trabeculectomy or tube shunt) and selective laser trabeculoplasty (SLT). Univariate comparisons were performed using chi-squared tests for categorical variables. Predictors for treatment were identified using logistic regression models.
Of the 159,282 patients with POAG under Medicare billing codes, 3,199 (2.01%) patients underwent incisional surgery for glaucoma and 9,446 (5.9%) patients had SLT. In the population, 66,446 (41.7%) were male, and 20,403 (12.8%) patients were 90+ years. There was a significant trend of decreased incisional and laser surgery as age group increased by 5 years (p<0.0001). Predictors of glaucoma surgery in all POAG patients included age group 85-89 years compared to 65-69 years (OR=0.87, 95% CI =[0.76, 0.99], p-value 0.03), 90+ years compared to 65-69 years (OR=0.57, 95% CI=[0.49, 0.67], p-value 0.00). CCI score of 3-4 compared to 0 (OR=0.90, 95% CI=[0.81, 1.00], p-value 0.04) and CCI score of 5+ compared to 0 (OR=0.87, 95% CI=[0.78, 0.98], p-value 0.01) were predictors as well. Significant predictors of SLT included age 85-89 years (OR=0.90, 9% CI=[0.83, 0.98], p-value 0.01) and 90+ years (OR=0.68, 95% CI=[0.62, 0.74], p-value 0.00) compared to 65-69 years of age as well as CCI score of 5+ compared to CCI score of 0 (OR=0.89, 95% CI=0[0.83, 0.95], p-value 0.001).
There was a significant decrease in the rate of incisional and laser surgery for glaucoma as age increased in this population of glaucoma patients. A higher CCI may predict a lower likelihood of undergoing incisional or laser surgery for glaucoma.
This is a 2020 ARVO Annual Meeting abstract.
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