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Glaucoma diagnosis rates vary widely by region, study shows
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The prevalence of various glaucoma types varied significantly by region, according to a study of Medicare claims data.
“Future research aimed at determining disparities in glaucoma care will need to account for these regional differences in diagnosis,” the study authors said. “The extremely low rate of ACG suggests under-diagnosis of ACG across all regions, and suggests a failure of clinical care, which needs to be investigated.”
Investigators retrospectively analyzed a 5% random sample of Medicare claims submitted between 2002 and 2008 for patients aged 65 years or older. They compared diagnosis rates for nine major geographic regions and 179 subregions.
Raw study data showed that the overall prevalence of all types of diagnosed glaucoma increased from 10.4% in 2002 to 11.9% in 2008. This trend was largely attributed to open-angle glaucoma diagnoses increasing from 3.2% to 4.5%. The prevalence of other glaucoma types remained relatively static.
The New England and Mid-Atlantic regions had the highest rates of diagnosed open-angle glaucoma (OAG), OAG suspects and angle-closure glaucoma (ACG) suspects. The East South Central and Mountain regions had the lowest rates.
Beneficiaries in the New England and Mid-Atlantic regions were 1.7 times more likely than those in the East South Central region to have an OAG-suspect diagnosis.
The New York sub-region had the highest diagnosis rate for all types of glaucoma.
“Regionally higher diagnosis rates in the New York area deserve further study,” the authors said.
A lower-than-expected rate of ACG may be attributed to failure to perform gonioscopy, the authors said.
Perspective
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Douglas J. Rhee, MD
This study provides descriptive statistics regarding the prevalence of various glaucoma diagnoses. In general, there was an increase driven largely by the growth of glaucoma suspects. It would be difficult to surmise the causes which are likely multifactorial and range from a true increase in the number of cases to increased awareness.
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