Visual field testing in glaucoma Medicare beneficiaries before surgery
Received 11 May 2004; accepted 17 September 2004. published online 07 January 2005.
Objective
The standard of care for progressive glaucoma that requires medical or surgical intervention includes visual field (VF) testing at least annually. This study aims to assess how commonly ophthalmologists perform VF testing before planned glaucoma surgery in the Medicare population, and whether variations in conformance occur across demographic and clinical subgroups.
Data were obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States from 1995 to 1999. The proportion of patients with evidence of at least 1 VF examination in the year before glaucoma surgery was determined.
Main outcome measure
Rate of VF testing in the year before glaucoma surgery.
Results
Overall, 70% of patients had at least 1 VF test in the year preceding glaucoma surgery. This rate was significantly lower (P<0.001) in patients ≥85 years (56%), blacks (64%), patients with race other than white or black (66%), patients with diabetic retinopathy (60%), and patients with bilateral blindness (47%).
Conclusions
The use of VF testing before surgery in glaucoma Medicare beneficiaries is suboptimal relative to the recommended standard of care. Underutilization is of particular concern in blacks, who are at increased risk of glaucomatous damage. Quality-of-care initiatives are needed to facilitate appropriate preoperative evaluations of glaucoma Medicare beneficiaries for glaucoma surgery.
1Jules Stein Eye Institute and the UCLA Department of Ophthalmology, Los Angeles, California
2The UCLA Robert Wood Johnson Clinical Scholars Program, Los Angeles, California
3The UCLA School of Public Health, Los Angeles, California
4The Boston University School of Medicine Department of Ophthalmology, Boston, Massachusetts
Reprint requests to Dr Anne L. Coleman, Jules Stein Eye Institute, 100 Stein Plaza, Los Angeles, CA 90095-7004
Manuscript no. 240358.
Supported in part by the National Eye Institute, Bethesda, Maryland (grant no.: EY00339) (ALC); Research to Prevent Blindness, New York, New York (unrestricted award to Jules Stein Eye Institute); the Center for Eye Epidemiology, Jules Stein Eye Institute, Los Angeles, California; and the Robert Wood Johnson Foundation Clinical Scholars Program, Princeton, New Jersey.
ABSTRACT