Glaucoma procedures decreasing among Medicare beneficiaries

Despite an increase in Medicare beneficiaries since 1994, the number of glaucoma-related surgeries has decreased, according to a recent study published in Ophthalmology.

The study-which analyzed Medicare fee-for-service paid claims data between 1994 and 2012-looked at what surgical treatments were used most for glaucoma, and how the volume of these surgeries has changed over the years.  

Canaloplasty, mini-shunts (external approach), aqueous shunt to extraocular reservoir, and endocyclophotocoagulations (ECP), were among the procedures that demonstrated a significant increase in use.

Read why this data surprised the study's authors

According to the data, trabeculectomies in eyes without previous scarring decreased 52% from 54 224 in 1994 to 25 758 in 2003, and another 52% to 12 279 in 2012.

Trabeculectomies in eyes with scarring ranged from 9054 to 13 604 between 1994 and 2003, but then decreased 48% from 11 018 to 5728 between 2003 and 2012. Mini-shunts done through an external approach increased 116% from 2718 in 2009 to 5870 in 2012.

The number of aqueous shunts to the extraocular reservoir increased 231% from 2356 in 1994 to 7788 in 2003, and another 54% to 12 021 in 2012. Total cyclophotocoagulation procedures increased 253% from 2582 in 1994 to 9106 in 2003, and another 54% to 13 996 in 2012.

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Transscleral cyclophotocoagulations decreased 45% from 5978 to 3268 between 2005 and 2012. Over the same period, the number of endoscopic cyclophotocoagulations (ECPs) increased 99% from 5383 to 10 728.

From 2001 to 2005, the number of trabeculoplasties more than doubled from 75 647 in 2001 to 176 476 in 2005. However, since 2005. the number of trabeculoplasties decreased 19% to 142 682 in 2012.

Next: Taken aback by findings

The number of laser iridotomies was consistent between 1994 and 2012, increasing 9% and ranging from 63 773 to 85 426. Canaloplasties increased 1407% from 161 in 2007 to 2426 in 2012.

Between 1994 and 2012-despite a 9% increase in beneficiaries-the number of glaucoma procedures and the number of glaucoma procedures other than laser procedures decreased 16% and 31%, respectively.

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“There is a great deal of innovation occurring in the glaucoma surgical space,” said Pradeep Ramulu, MD, PhD, co-author of the study. “Many newer procedures gained significant market share, suggesting that doctors are open to exploring new surgical treatments for the disease.”

Nevertheless, Dr. Ramulu said he was taken aback by these findings, as well as the decrease in glaucoma procedures, even though there was an increase in Medicare beneficiaries.

“We hope this reflects better medical treatment, and not neglect of needed surgical therapy,” said Dr. Ramulu, an associate professor of ophthalmology at Johns Hopkins Wilmer Eye Institute. “Also, it is was surprising to see the ascension of newer glaucoma procedures.

“In particular, we were surprised to see that there are almost as many ECPs performed as compared to primary trabeculectomies,” he added.

According to the study, the continued movement away from trabeculectomy and toward alternative IOP-lowering procedures highlights the need for well-designed clinical trials comparing the procedures.

“As new procedures emerge, we hope that they are well-studied and well-evaluated,” said Dr. Ramulu. “The glaucoma surgical community is open to the emergence of new procedures, and patients, companies, and physicians alike will benefit if these procedures are well studied and their results, indications, and contraindications well-documented.”

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