Abstract
Purpose :
The purpose of this study is to better understand imaging modality utilization for diagnosis of glaucoma over the past decade through analysis of trends among glaucoma specialists. Understanding these trends may contribute to proper planning and development of the healthcare apparatus and newer machine learning models.
Methods :
This was a retrospective study of Medicare Provider Utilization and Payment Data from 2012-2019, which is a publicly available aggregate of nationwide information on services and procedures provided to Medicare beneficiaries on a fee-for-service basis. 556 glaucoma providers were identified throughout the Unites States. Procedure count for 92250 (fundus photography with interpretation and report), 92133/92134 (scanning computerized ophthalmic diagnostic imaging with interpretation and report), 92083 (visual field examination with interpretation and report), and 92020 (gonioscopy) were obtained. Trends were analyzed using Mann-Kendall trend test.
Results :
Each testing modality increased over the eight year period studied, with the greatest percent increase in optical coherence tomography (OCT) (89.2%). Color fundus photography represented the lowest average year over year increase (Figure 1). A direct ratio of fundus photographs to OCTs showed a downward trend, where in 2012 one fundus photograph was taken for every 3.3 OCTs and in 2019 one fundus photograph was taken for every 4 OCTs (p-value 0.004).
Reimbursements did not decrease significantly for gonioscopy throughout the study period (p-value 0.53619) and decreased for the remaining three modalities. Fundus photography reimbursement decreased by 30% (p-value 0.173), OCT decreased by 20% (p-value 0.009) and visual field testing decreased by 31% (p-value =0.035) (Figure 2).
Conclusions :
While visual field testing and color fundus photography did increase in the period analyzed, the change in OCT use increased by almost double. At the current rate, vanishingly few fundus photographs will be captured as part of the management of glaucoma patients. This paradigm shift represents an important change in the field.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.