Abstract
Purpose :
To review the initial evaluation of neovascular glaucoma (NVG) patients by ophthalmology residents at an urban hospital outpatient clinic. To evaluate socioeconomic disparities, treatment modalities, clinical and economic burden, and outcomes surrounding NVG.
Methods :
A retrospective chart review of 940 patients evaluated between 2019 and 2021 at MedStar Washington Hospital Center/Washington National Eye Center was completed. Demographic information collected included gender, ethnicity, age at diagnosis, and primary language. Patients’ initial intraocular pressure (IOP) measurements and ophthalmic diagnoses were collected. For patients given a diagnosis of NVG, additional data was obtained including initial presenting and most- recent visual acuities (VA) and IOP, associated etiology of NVG, number of anti-vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) procedures performed, surgical interventions, and number of clinic visits for the acute management of NVG (during the 1-year period after initial diagnosis). Estimated cost of clinic visits and procedures were calculated using Medicare data and the 2019-2021 Physician Fee Schedule.
Results :
Of the 940 reviewed patient charts, 11 (1.2%) had a diagnosis of NVG. Four identified as female (36.3%), the mean age at diagnosis was 53 years, 20% of this population were Spanish speaking, and 80% were African American. All patients in this cohort were minorities. NVG was secondary to proliferative diabetic retinopathy in 54.5% of patients, 36% of patients received care via DC Medicaid, and one patient was uninsured at diagnosis. The average presenting IOP was 29.5mmHg. Patients averaged 12.5 office visits, 6.9 anti-VEGF injections, and 1.3 PRP over a one year period. Three patients underwent cyclophotocoagulation and one patient underwent incisional glaucoma surgery. Visual acuity outcomes were no better than 20/60 and 55% of patients are hand motion or worse. Of note, four patients were lost to follow-up, and one died. The estimated annual average total cost per patient was $5,461.53 ± $5,196.36 (range $321.90-$17,092).
Conclusions :
Neovascular glaucoma requires frequent clinic visits, extensive procedural care, and often results in poor outcomes. Our study highlights racial disparities in patients diagnosed with NVG and the disproportionate economic burden it places on the healthcare system.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.