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Rate of repeat laser trabeculoplasties higher for Oklahoma ODs than for ophthalmologists
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FORT LAUDERDALE, Fla. — A larger proportion of laser trabeculoplasties required one or more additional sessions when performed by optometrists in Oklahoma than when performed by ophthalmologists in that state, according to a study of health care data.
“Oklahoma, as we all know, is one of the few states where optometrists have surgical privileges to perform laser procedures,” Joshua D. Stein, MD, said at the American Glaucoma Society meeting. “Optometrists in other U.S. states are actively lobbying to get permission to obtain privileges to do these procedures, so it is critically important to assess whether the outcomes of lasers performed by these two groups are comparable or not.”
Stein reported findings from a study comparing outcomes of Medicare enrollees undergoing laser trabeculoplasty by ophthalmologists and by optometrists
The data source was a nationally representative 20% sample of all enrollees in Medicare from 2008 to 2013; the sample selection included enrollees with any type of glaucoma (ICD code 365.xx) residing in the state of Oklahoma who underwent laser trabeculoplasty (CPT code 65855). No distinction was made in the database regarding the type of laser trabeculoplasty used. Patients younger than 65 years and older than 95 years were excluded.
Stein and colleagues found a “highly” statistically significant difference (P < .0001) between the rates of re-treatment for ophthalmologists (15%) and optometrists (36%).
The difference in time between treatment and subsequent treatment in both groups was most apparent early, Stein said, with one-fourth of the patients requiring subsequent laser trabeculoplasty among those performed by ophthalmologists at a median of 59 months, and the median time for those done by optometrists at 5.8 months.
“We identified large differences in outcomes between patients undergoing laser trabeculoplasty by ophthalmologists and optometrists. Additional research is required to investigate why such a high proportion of patients receiving laser by optometrists require additional laser relative to those seeking care by an ophthalmologist and whether there’s a difference in the quality of care. And we believe health policy makers should be very cautious about approving laser privileges for optometrists practicing in other U.S. states until we thoroughly understand some of the differences that we’re seeing here.” Stein said. – by Patricia Nale, ELS
Disclosure: Stein reports he receives funding support from Research to Prevent Blindness and the American Academy of Ophthalmology.