Abstract
Purpose :
To analyze regional trends in retinal imaging utilization and treatment with anti-vascular endothelial growth factor (VEGF) and panretinal photocoagulation (PRP) for US Medicare Part B beneficiaries.
Methods :
We performed a cross-sectional study utilizing the publicly available Medicare Physician & Other Practitioners - by Provider and Service database to analyze regional trends in retinal imaging, anti-VEGF injection, and PRP utilization among all ophthalmologists from 2013 to 2021. Regions were classified as Midwest, Northeast, South, and West. Data were identified using Current Procedural Terminology (CPT) codes specifically for aflibercept, ranibizumab, bevacizumab, ocular coherence tomography (OCT), fundus photography (FP), fluorescein angiography (FA), ICGA (indocyanine green angiography), ophthalmic ultrasound (US), anti-VEGF, and PRP.
Results :
The primary outcome measures were the regional count per 1000 Medicare beneficiaries and relative utilization over time of retinal imaging modalities as well as anti-VEGF and PRP usage. Across all years of the study period, there was significant variation by region in the usage per 1000 Medicare beneficiaries of FA (p < 0.001), FP (p < 0.001), OCT (p < 0.001), and US (p < 0.001), with the Midwest having the lowest utilization across all categories and the Northeast having the highest utilization across FP, OCT and US. Significant variation by region for FA+ICGA (p < 0.05) was only observed for the years 2018 through 2021. For both PRP and anti-VEGF injections, significant variation (p < 0.001) by region was observed in all years of the study period, where PRP use was highest in the South and anti-VEGF use was lowest in the West.
Conclusions :
Per 1000 Medicare beneficiaries, the Northeast had the highest utilization of OCT and US, while the Midwest had the lowest utilization of OCT, US, FA, FA+ICGA, and FP. OCT continues to rise as a percentage of all retinal imaging ordered, while FA continues to fall, despite stable regional differences.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.