Abstract
Purpose :
Current practice guidelines recommend all patients receive gonioscopy during initial glaucoma evaluation. However, there is evidence that gonioscopy is underperformed, which could lead to misclassification of glaucoma subtypes and missed opportunities for intervention. This study investigates the reported rate of gonioscopy in United States as well as the socio-demographic and clinical characteristics associated with lower likelihood of gonioscopy.
Methods :
This was a retrospective, case-control study of patients in the Optum Clinformatics® Data Mart Database undergoing initial glaucoma evaluations between 2008 to 2020. Initial glaucoma evaluation was defined as: 1) diagnosis of glaucoma suspect, anatomical narrow angle, or glaucoma (open angle, angle closure, or secondary) by an ophthalmologist based on International Classification of Diseases (ICD) codes; 2) continuous observability during a 24-month lookback period; 3) no history of drops, laser procedures, or glaucoma surgery; 4) optical coherence tomography of nerve fiber layer or visual field performed on or within 6 months of the initial diagnosis. Gonioscopy performed within the 6 months period was identified based on Current Procedural Terminology (CPT) codes. Logistic regression modeling was performed to determine factors associated with lack of gonioscopy.
Results :
Among 293,746 included patients, 56.1% were female, and average age at diagnosis was 64.9±15.0 years. There were 64.0% non-Hispanic Whites, 13.1% Blacks, 12.3% Hispanics, and 6.3% Asians. Overall, 29.7% received gonioscopy within 6 months of initial evaluation. Non-Hispanic Whites race, age older than 60 years, pseudophakia/aphakia status, and residence outside of the Northeast were risk factors for lack of gonioscopy (OR<0.83, p<0.001). Compared to patients diagnose with anatomical narrow angle, patients with other diagnoses had a lower likelihood of receiving gonioscopy (OR <0.86, p<0.001).
Conclusions :
Most patients undergoing initial glaucoma evaluation in the United States do not receive gonioscopy. The elderly, non-Hispanic Whites, pseudophakes, and residents outside of the Northeast region are less likely to receive gonioscopy.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.