Abstract
Purpose :
To examine factors associated with use of minimally invasive glaucoma surgery (MIGS) at the time of phacoemulsification in patients with primary open angle glaucoma (POAG) in the 2016-2017 California (CA) Medicare Population.
Methods :
The study population included all patients with administrative billing codes for POAG and phacoemulsification in the 2016-2017 CA Medicare database. Exposures that were examined included age, gender, race, Charlson Comorbidity Index (CCI) score, age-related macular degeneration (AMD), diabetic retinopathy (DR), and severe cataract. The main outcome measure was use of MIGS at the time of phacoemulsification. This was defined by procedure codes for trabecular micro-bypass stent, goniotomy, canaloplasty, or cyclophotocoagulation. Logistic regression modeling was used to identify multivariable predictors of MIGS use at the time of phacoemulsification separately in 2016 and 2017, with all study covariates included in the statistical model.
Results :
In the CA Medicare population, there were 11,003 POAG patients in 2016 and 11,269 in 2017 who underwent phacoemulsification, of whom 3,987 (36.2%) had MIGS in 2016 and 4,331 (38.4%) in 2017. In 2016, multivariable associations with MIGS included age 80-84 (odds ratio [OR]=0.86, 95% confidence interval [CI]=0.75, 0.98), 85-89 (OR=0.80, 95% CI=0.68, 0.94), and 90+ (OR=0.74, 95% CI=0.59, 0.93) versus 65-69, Asian (OR=0.83, 95% CI=0.74, 0.93) and Hispanic (OR=0.88, 95% CI=0.79, 0.99) versus white race, CCI score 1-2 versus 0 (OR=0.91, 95% CI=0.82, 1.00), and DR (OR=0.74, 95% CI=0.63, 0.86). In 2017, multivariable associations with MIGS use included age 85-89 (OR=0.74, 95% CI=0.63, 0.86) and 90+ (OR=0.70, 95% CI=0.56, 0.88) versus 65-69, Asian (OR=0.86, 95% CI=0.77, 0.96) and Hispanic (OR=0.90, 95% CI=0.80, 1.00) versus white race, DR (OR=0.75, 95% CI=0.65, 0.87), CCI 1-2 (OR=1.10, 95% CI=1.00, 1.22) and 3-4 (OR=1.13, 95% CI=1.01, 1.27) versus 0, and severe cataract (OR=1.10, 95% CI=1.02, 1.19).
Conclusions :
In California Medicare patients with POAG and phacoemulsification in 2016 and 2017, a higher proportion received phacoemulsification alone compared to phacoemulsification with MIGS. Potential factors associated with decreased MIGS use included older age, Asian and Hispanic race, and diabetic eye disease. Further studies are needed on patient selection for MIGS during phacoemulsification.
This is a 2021 ARVO Annual Meeting abstract.