Abstract
Purpose :
An important driver of glaucoma treatment costs is surgery, including traditional surgical interventions as well as minimally invasive glaucoma surgeries (MIGS), which are gaining in popularity. To analyze current trends in glaucoma surgeries, this study conducted a retrospective, population-based analysis using the 2011-2021 Centers for Medicare and Medicaid Services Part B National Summary database.
Methods :
All relevant cases of trabeculectomy, glaucoma drainage implants (GDIs), and various MIGS including iStent, goniotomy, trabeculectomy, endocyclophotocoagulation (ECP), CyPass, Ab externo shunts, Transluminal dilation, and XenGel, were queried from the database using Current Procedural Terminology (CPT) codes. Linear regression analyses were performed using Python.
Results :
Adjusting for inflation to 2021 equivalents, total Medicare part B payment for the selected glaucoma procedures increased from $71.5 million in 2011 to $246.1 million in 2021 (p<0.001). Total glaucoma surgeries increased by 176.66%, from 80,151 in 2011 to 221,602 in 2021 (p<0.001). Trabeculectomies had a 58.5% decline, dropping from 32,145 in 2011 to 13,345 in 2021 (p<0.001). GDI showed fluctuation over the years, increasing from 17,848 in 2011 to 21,323 in 2013, followed by a decline to 17,337 in 2021. iStent, approved by the FDA in 2012, increased 247,141.67% from 42 in 2011 to 103,601 in 2021 (p<0.001). Between 2011 and 2015 the number of goniotomies rose from 95 to 249. By 2021, this number increased by 15,231.73% to 38,159 goniotomies (p<0.001), making up 17.2% of total glaucoma procedures in 2021. The number of transluminal dilations followed a similar trend, increasing by 7,544% from 399 in 2011 to 30,540 in 2021 (p=0.001). Ab externo shunts experienced an initial decline from 9,947 in 2011 to 3,973 in 2018, followed by an increase to 11,531 in 2021. ECP decreased by over 94%, from 19,675 in 2011 to 1,158 in 2021 (p=0.003). Notably, iStent accounted for 46.8% of all glaucoma procedures by 2021.
Conclusions :
iStent has emerged as the predominant procedure for glaucoma among Medicare recipients, accounting for almost 50% of glaucoma surgeries in 2021. Notably, there was a significant decline in trabeculectomies, contrasting with the stable numbers of GDIs. Goniotomies and transluminal dilations had substantial increases over the study period. Ab externo shunts exhibited fluctuation, while ECP experienced a large reduction.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.