Projected 24-hour post-dose ocular itching scores post-treatment with olopatadine 0.7% versus 0.2.

Olopatadine is an antihistamine and mast cell stabilizer used for treating allergic conjunctivitis. Olopatadine 0.7% has been recently approved for daily dosing in the US, which supersedes the previously approved 0.2% strength. The objective of this analysis was to characterize patients who have better itching relief at 24 h when taking olopatadine 0.7% treatment instead of olopatadine 0.2% (in terms of proportions of responses) and relate this to the severity of baseline itching as an indirect metric of a patient's sensitivity to antihistamines. A differential odds model was developed using data from two conjunctival allergen challenge (CAC) studies to characterize individual-level and population-level response to ocular itching following olopatadine treatment and the data was analyzed retrospectively. This modeling analysis was designed to predict 24 h ocular itching scores and to quantify the differences in 24 h itching relief following treatment with olopatadine 0.2% versus 0.7% in patients with moderate-to-high baseline itching. A one-compartment kinetic-pharmacodynamic Emax model was used to determine the effect of olopatadine. Impact of baseline itching severity, vehicle effect and the drug effect on the overall itching scores post-treatment were explicitly incorporated in the model. The model quantified trends observed in the clinical data with regards to both mean scores and the proportions of patients responding to olopatadine treatment. The model predicts a higher proportion of patients in the olopatadine 0.7% versus 0.2% group will experience relief within 24 h. This prediction was confirmed with retrospective clinical data analysis. The number of allergy patients relieved with olopatadine 0.7% increased with higher baseline itching severity scores, when compared to olopatadine 0.2%.

The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity.

OBJECTIVE: The purpose of the study was to examine (1) how patient adherence and eye drop technique were associated with visual field defect severity and (2) how general glaucoma adherence self-efficacy and eye drop technique self-efficacy were related to visual field defect severity. DESIGN: Cross-sectional study conducted at a single private practice site. PARTICIPANTS: Patients using eye drops for their glaucoma. METHODS: Subject adherence to glaucoma medications through Medication Events Monitoring System (MEMS) devices were measured, and eye drop instillation technique was assessed by video recording. General glaucoma medication adherence self-efficacy was measured using a 10-item scale, and eye drop technique self-efficacy was measured using a 6-item scale. Multivariate logistic regression was used to analyze the data. MAIN OUTCOME MEASURES: Visual field defect severity. RESULTS: Patients who were less than 80% adherent according to the MEMS devices were significantly more likely to have worse defect severity. Patients with lower scores on the general glaucoma medication adherence self-efficacy scale also were significantly more likely to have worse defect severity. Eye drop technique and eye drop technique self-efficacy were not related significantly to visual field defect severity. CONCLUSIONS: Eye care providers need to assess patient adherence and to work with those patients with poor adherence to find ways to improve their ability and self-efficacy in using their glaucoma medications. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Videotaped evaluation of eyedrop instillation in glaucoma patients with visual impairment or moderate to severe visual field loss.

PURPOSE: Objectively evaluate the ability of visually disabled glaucoma patients to successfully administer a single drop onto their eye. DESIGN: Prospective, observational study. PARTICIPANTS: Experienced glaucoma patients with Early Treatment of Diabetic Retinopathy Study visual acuity (VA) of ≤ 6/18 (≤ 20/60) ≥ 1 eye, or moderate or severe visual field damage in ≥ 1 eye. METHODS: Subjects were "low vision" (20/60 ≤ VA <20/200) or "blind" (light perception 6 months. Subjects used a mean of 1.9 ± 1.1 bottles of intraocular pressure-lowering medications to treat their glaucoma. Seventy-six percent (155/204) of subjects had severe visual field damage, with a mean deviation of -14.5 ± 8.0. Twenty-six percent (54/204) had acuity of ≤ 20/200 in ≥ 1 eye, and subjects had a mean logarithm of minimal angle of resolution acuity of 0.8 ± 0.9. Seventy-one percent of subjects were able to get a drop onto the eye; only 39% instilled 1 drop onto the eye without touching the ocular surface, instilling a mean 1.4 ± 1.0 drops, using 1.2 ± 0.6 attempts. Of the 142 subjects who denied touching the bottle to the ocular surface, 24% did touch the bottle to the eye. Multiple factors were tested for ability to predict successful application of an eyedrop; however, only age (< 70 vs ≥ 70 years) was found to be a significant predictor for less successful instillation. CONCLUSIONS: In this video analysis of visually impaired glaucoma patients, we evaluated the difficulty this population has instilling eyedrops, most important, the use of multiple drops per instillation, potential contamination of a chronically used bottle, and poor patient understanding of the situation. Ability to self-administer eyedrops and cost considerations of wasted drops must be thought out before institution of glaucoma therapy. Efforts to determine better methods of eyedrop administration need to be undertaken.

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients.

OBJECTIVE: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients. METHODS: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week. RESULTS: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37-93 years]; black race, 45.4%; white race, 44.0%; "other" or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported > or =1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were "drops fall on cheek" (29.1%), "too many drops come out" (20.6%), and "hard to read print" (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05). CONCLUSION: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.

Medicare expenditures associated with diabetes and diabetic retinopathy.

BACKGROUND: To estimate the expenditures for diabetic retinopathy in the United States by Medicare. METHODS: Retrospective data analysis using the 1997 through 2004 5% Medicare claims data. A case control design was used; eligible beneficiaries were 65 or older and without major ophthalmic conditions (cataract, cataract surgery, and macular degeneration) during the study period. Controls had diabetes but no evidence of diabetic retinopathy. There were two diabetic retinopathy case groups: beneficiaries with nonproliferative diabetic retinopathy (NPDR) and beneficiaries with proliferative diabetic retinopathy (PDR). Analyses quantified annual Medicare payments for case and control groups. RESULTS: A total of 178,383 controls, 33,735 NPDR cases, and 6,138 PDR cases were identified. After adjusting for age, sex, and race, annual average Medicare payments for all care were significantly higher for case groups compared to the control group, as were average payments for ophthalmic care only (all P < 0.0001). In addition, average payments for all care and for ophthalmic care were substantially higher for PDR cases compared to NPDR cases. CONCLUSION: These findings demonstrate substantial expenditures associated with diabetic retinopathy, and with PDR in particular, only part of which is due to ophthalmic care. Delaying progression may be associated with decreased Medicare expenditures.

Impact of visual impairment on service and device use by individuals with diabetic retinopathy.

PURPOSE: This study was performed to assess the use of devices and caregiving among individuals with diabetic retinopathy and to evaluate the impact of visual acuity on use. METHODS: Data were collected using a questionnaire that included items on demographic and clinical characteristics and on the use of services, assistive devices, and caregiving. The study was approved by an institutional review board. Two ophthalmologists identified and invited patients with diabetic retinopathy and provided best corrected visual acuity (BCVA). Patients provided informed consent. De-identified data were analysed in SAS(R). RESULTS: Of the 806 respondents, 55% were women; mean age was 65 years. Respondents were classified into five categories based on BCVA. Few respondents used services such as transportation and counseling, but there was wide use of assistive devices. More than 20% of respondents used a cane, a hand-held magnifier, and/or special glasses. The mean number of devices used increased significantly as BCVA deteriorated, as did hours of caregiving. Annual costs for services, devices, and caregiving increased as BCVA deteriorated. CONCLUSIONS: There are substantial differences in the use and costs of assistive devices and caregiving among individuals with diabetic retinopathy with varying BCVA.

Patient-reported barriers to glaucoma medication access, use, and adherence in southern India.

The objectives of the study were to (a) describe the different types of problems that patients in southern India reported having when taking their glaucoma medications and (b) examine the relationship between patient reported-problems in taking their glaucoma medications and the self-reported patient adherence. A survey was conducted by clinical staff on 243 glaucoma patients who were on at least one glaucoma medication in an eye clinic in southern India. We found that 42% of patients reported one or more problems in using their glaucoma medications. Approximately 6% of patients reported being less than 100% adherent in the past week. Unmarried patients and patients who reported difficulty squeezing the bottle and difficulty opening the bottle were significantly more likely to report nonadherence.

Cost comparison of prostaglandin analogues: a Canadian population-based analysis.

OBJECTIVES: Glaucoma is a fairly common disease, however, little is known about the costs associated with prostaglandin analogues (PAs). The costs between the three available PAs (Lumigan (bimatoprost), Xalatan (latanoprost) and Travatan (travoprost)) were compared as monotherapy and when adjunctive therapy was used. METHODS: From the Québec drug claims database, all patients who used these drugs for 1 full year were identified. From the Ministry of Health (MoH) perspective, the average cost for all reimbursed costs (drug costs and pharmacist fees) were calculated. Those costs plus the patient out-of-pocket copayments were used for the payer + user (PU) perspective. RESULTS: Data from 4,653 patients were analysed (3,606 on monotherapy and 1,047 on combination treatment with adjunctive therapy), 59.7% were females, and the average age was 72.6 +/- 10.4 years. MoH perspective costs were $410 +/- $167 for bimatoprost, $381 +/- $145 for latanoprost and $298 +/- $121 for travoprost (all differences p<0.001), for patients on monotherapy. Costs of combination treatment with adjunctive therapy were $786 +/- $416, $686 +/- $313, and $623 +/- $521, respectively (travoprost significantly lower than each of the other two p<0.001, others=not significant). Results from the PU perspective were comparable. CONCLUSIONS: Travoprost had the lowest cost, both as monotherapy and in conjunction with other glaucoma treatments. Further comparative pharmacoeconomic evaluation is warranted.

Evaluation of Medicare costs of endophthalmitis among patients after cataract surgery.

PURPOSE: Endophthalmitis, an ophthalmic condition characterized by an inflammation of the intraocular cavity, can have substantial implications for vision. However, little is known about the cost of treatment. The objective of this study was to estimate the direct medical cost of treatment for endophthalmitis in the United States. DESIGN: Retrospective data analysis using the 1997 through 2001 Medicare Beneficiary Encrypted Files. PARTICIPANTS: Beneficiaries who underwent cataract surgery were identified; baseline and clinical characteristics at the time of diagnosis were determined. Analyses stratified patients based on development of endophthalmitis in the year after surgery. METHODS: Claims and reimbursements for cases (patients undergoing cataract extraction in whom endophthalmitis developed) and controls (patients who did not experience endophthalmitis) were determined and rates of resource use and costs were calculated from the perspective of Medicare. MAIN OUTCOME MEASURES: Annual Medicare payments and claims. RESULTS: A total of 417 beneficiaries with endophthalmitis occurring after cataract surgery were found; 139 558 had cataract surgery without subsequent endophthalmitis. Three fifths of beneficiaries were female and 89% were white. Ophthalmic claims and reimbursements were more than 1.45 times greater for cases than controls ($12 578 in higher claims and $3464 in higher reimbursements; P<0.0001). CONCLUSIONS: These findings demonstrate a substantial cost associated with endophthalmitis. With recent studies suggesting that prophylaxis is effective in preventing endophthalmitis, there is potential that inexpensive prophylaxis could result in cost and resource savings to Medicare.

Quality of life and health economic assessments of age-related macular degeneration.

In this article, we review measures of patient-reported outcomes that can show whether a treatment for age-related macular degeneration also provides patient-perceived benefits. In addition, we look at health economic measurements currently being used to develop cost-effectiveness models for age-related macular degeneration.

Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use.

PURPOSE: To determine with electronic monitoring an objective measurement of adherence in two populations of subjects: those using once-daily prostaglandin analogs as sole ocular hypotensive therapy (one-drug group) and those requiring an adjunctive medicine to the prostaglandin analog (two-drug group). DESIGN: Single-site, open-label, nonrandomized, parallel design of 60 days. METHODS: Sixty-two consecutive adult subjects with a diagnosis of open-angle glaucoma (OAG) or ocular hypertension: 31 were taking one drug and 31 were taking two drugs. An electronic event medication monitoring device was used to record each bottle opening. The main outcome measures were dosing errors (number of under-adherence or over-adherence events) and coverage (proportion of pharmacologic duration covered by dosing) relative to the ophthalmologist-prescribed regimen. RESULTS: Adherence to the prostaglandins once daily was good in both groups by all measures (

Resource Utilization Among Glaucoma Patients in the UK Treated with Beta-Blocker and Non-Beta-Blocker Adjunctive Therapy: A Retrospective Cohort Analysis.

INTRODUCTION: Few studies have examined outcomes and potential complications among glaucoma patients who are prescribed topical beta-blockers. This study examined resource usage (number of GP visits and hospitalizations) and diagnoses of respiratory or cardiovascular conditions among glaucoma patients prescribed beta-blockers compared to patients not prescribed beta-blockers. METHODS: A retrospective cohort analysis was conducted using data from the UK Clinical Practice Research Datalink (CPRD) database over the period January 1, 2006 to March 31, 2014. Adult patients with at least one diagnosis of glaucoma were categorized into beta-blocker users and non-beta-blocker users. Beta-blocker users were further separated into patients that maintained beta-blocker therapy and patients that discontinued beta-blocker treatment in year 2 of the post-index period. The CPRD data was queried directly to obtain the number of GP visits, and hospitalizations were extracted by linking the CPRD and Hospital Episode Statistics (HES) patient-level data. RESULTS: In the 12 months after being prescribed beta-blockers, patients that later discontinued beta-blocker treatment had a significantly higher average number of hospitalizations than patients that maintained beta-blocker therapy and the non-beta-blocker users (p < 0.05). In the year after beta-blocker initiation, there was a statistically significant within-group difference pre- and post-beta-blocker initiation for all groups, but the greatest number of GP visits occurred in the patients that subsequently discontinued beta-blocker treatment (mean 19.27). Patients that discontinued beta-blocker treatment were significantly more likely to have cardiovascular events than non-beta-blocker users in the post-index period (p < 0.05). CONCLUSION: This study suggests that the introduction of beta-blockers in a certain group of patients who later discontinue their use is associated with increased use of medical resources (higher number of GP visits and hospitalizations) in glaucoma patients in the UK, which may be indicative of a potential relationship between use of topical beta-blockers in glaucoma therapy and adverse outcomes.

Patient-reported behavior and problems in using glaucoma medications.

OBJECTIVE: The objectives of the current study were to describe the different types of problems patients receiving adjunctive therapy reported having when taking their glaucoma medications and to examine the relationship between patient-reported problems in taking their glaucoma medications and patient adherence. DESIGN: Cross-sectional survey. PARTICIPANTS: A survey was distributed to glaucoma patients in 4 geographically distinct ophthalmology practices. We excluded patients using only 1 glaucoma medication. The survey was completed by 324 patients. METHODS: For each patient, average percent adherence to his or her glaucoma medication regimen was calculated. Logistic regression was used to examine how patient characteristics and problems in using glaucoma medications were related to reported adherence. MAIN OUTCOME MEASURE: Whether patients were less than 100% adherent in the previous week. RESULTS: We found that 60% of patients reported 1 or more problems with taking their glaucoma medications. Fourteen percent of patients reported being less than 100% adherent to their glaucoma regimen medications during the previous week. Patients who had difficulty remembering to take their glaucoma medications and those who reported that they had other problems or concerns with their glaucoma medications were significantly less likely to be 100% adherent. CONCLUSIONS: Patient adherence to a glaucoma medication regimen could be improved among patients receiving adjunctive therapy. Ophthalmologists and their clinical colleagues should make sure to discuss the problems and concerns that patients may have in taking their glaucoma medications in an effort to improve adherence.

Adjunctive glaucoma therapy use associated with travoprost, bimatoprost, and latanoprost.

PURPOSE: This study contrasts the utilization of adjunctive medication associated with travoprost, bimatoprost, or latanoprost, as primary glaucoma therapies. METHODS: Patients in the Medco Health database who initiated prostaglandin analog therapy on travoprost, bimatoprost or latanoprost between January 1, 2002 and July 31, 2002 were selected if they had no prostaglandin analog use in the prior 6 months. Patients were also required to have 12 months of prostaglandin therapy subsequent to the initial prescription. Data were available through July 31, 2003. The t-test and chi-square were used where appropriate to calculate p-values and assess significant differences. RESULTS: A total of 13 171 benefit-eligible subjects were identified of which 8381 (64%), 2637 (20%), and 2153 (16%) patients were treated with latanoprost, bimatoprost, and travoprost, respectively. There were no significant differences in mean age or gender between the three study groups with the exception that latanoprost patients were statistically older than travoprost patients (69.0 vs. 68.0). This was not considered a clinically meaningful difference. Overall, patients using travoprost or bimatoprost had a significantly lower rate of adjunctive medication use compared to patients starting on latanoprost monotherapy (22.5%, 23.2%, and 30.2 %, respectively). Therefore, for every 14 patients treated with latanoprost instead of travoprost or bimatoprost, one additional patient would be expected to need adjunctive therapy with another agent. The difference between travoprost and bimatoprost patients was not significant. CONCLUSIONS: The use of adjunctive medications to control intraocular pressure was significantly higher for latanoprost patients compared to travoprost and bimatoprost patients. This finding should be interpreted in the context that this study was based only on prescription claims data. It is important to simplify ophthalmic medical regimen as it is more cost effective, better for the patient, and minimizes the washout effect from administering two eye medications within 5 min. Decreasing the complexity of the patients' drug regimen may lead to increased adherence to prescribed therapy and a decreased risk of the incidence of blindness.

Travoprost versus latanoprost combinations in glaucoma: economic evaluation based on visual field deficit progression.

OBJECTIVE: Changes in intraocular pressure (IOP) are known to be related to visual field deficit progression, although multiple models of this relationship exist. In addition, visual functioning is known to affect medical costs. The objective of this study was to project visual field deficit progression and subsequent costs based on clinical trial data. RESEARCH DESIGN AND METHODS: Using data from a randomized, 12-month, double-masked study, we compared the use of a fixed combination of travoprost 0.004%/timolol 0.5% (T/T) versus a fixed combination of latanoprost 0.005%/timolol 0.5% (L/T) on visual field deficit progression and associated costs. We applied published algorithms linking IOP to visual field changes to calculate the likelihood of visual field deterioration by treatment group. Differences in medical care costs were estimated using guideline-recommended practice patterns, Medicare hospital costs, and published estimates of differences in hospitalization by visual functioning. MAIN OUTCOME MEASURES: Increase in visual field deficit progression rates, increase in annual hospital days per subject, and increase in annual hospital, outpatient, and total costs per subject. RESULTS: Predicted visual field deficit progression for T/T patients was less than that for L/T patients (not statistically significant). Projected annual medical care costs were 43 dollars lower for T/T vs. L/T patients. CONCLUSIONS: By applying published algorithms linking IOP to visual field changes, this study projected long-term visual field deficit and associated costs. Use of a fixed travoprost/timolol solution may lead to less long-term visual field deficit progression and lower annual medical care costs than a fixed latanoprost/timolol solution. DISCUSSION: The use of clinical trial data may limit the applicability of these findings. However, this analysis of direct medical costs only is likely a conservative estimate of the costs associated with visual field deficits.

Validation of the Daily Living Tasks Dependent on Vision (DLTV) questionnaire in a U.S. population with age-related macular degeneration.

PURPOSE: The Daily Living Tasks Dependent on Vision questionnaire (DLTV) has been used to assess functional impairment among patients with age-related macular degeneration (AMD). This study evaluated the psychometric properties of the DLTV using patient-reported rates of use of services and devices in an outpatient population. METHODS: The DLTV was included in a survey mailed to members of an AMD advocacy organization. Included in the survey were questions about demographic and clinical characteristics as well as questions about use of low vision aids and care-giving. Respondents provided informed consent. Data were analyzed in SAS. RESULTS: Four respondents of 803 did not complete the DLTV; missing data were uncommon. Most (56%) respondents were male; the mean age was 73 years. Internal consistency reliability of the DLTV was 0.9699. Construct validity was demonstrated with moderate to high correlations between the DLTV and use of services and devices. The DLTV demonstrated discriminant validity and could distinguish between respondents with different levels of impairment, i.e., those who reported regular care-giving compared to those without regular care-giving. CONCLUSIONS: In this outpatient population, the DLTV demonstrated reliability and validity. This analysis complements existing research and supports the use of the DLTV in AMD patients.

Resource utilization and costs of age-related macular degeneration.

Data were analyzed from the 1999-2001 Medicare Beneficiary Encrypted Files for patients with age-related macular degeneration (AMD), an ophthalmic condition characterized by central vision loss. Classifying AMD subtype by International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) (Centers for Disease Control and Prevention, 2003) code, resource utilization rates increased with disease progression. Individuals with more severe disease (wet only or wet and dry AMD) had greater costs than did those with less severe disease (drusen only or dry only). Costs among patients with wet disease increased yearly at rates exceeding inflation, possibly due in part to increased rates of treatment with photodynamic therapy among these individuals and the aging of the population.

Screening for glaucoma in Canada: a systematic review of the literature.

BACKGROUND: To provide a recommendation on screening for glaucoma in Canada based on a review of recent evidence available in the literature. METHODS: A systematic literature review was performed to identify publications from MEDLINE, EMBASE, HealthSTAR, and Cochrane databases from 1990 to 2005. Relevant articles were categorized as economic studies, epidemiologic and intervention studies, or policy papers. Web sites and publications from provincial, state, national, and international health authorities were reviewed for policy recommendations and guidelines. RESULTS: We identified 39 articles (34 epidemiology and intervention, and 5 economic studies) for the review. From the economic studies, 2 were simple cost analyses and 3 were full economic evaluations (cost-effectiveness). Gaps were observed from these economic studies, where incremental cost-effectiveness analyses of modelled screening programmes were not observed. A large number of alternatives (i.e., screening techniques) and diverse outcome measures were found in the 34 epidemiology and intervention studies. This shows that evidence on the effectiveness of glaucoma screening programmes is available to be used in future modelled analyses. Neutral recommendation made by the Canadian Task Force on Periodic Health Examination regarding glaucoma screening in Canada could be related to the lack of reliable data and models used in past cost-effectiveness analyses. INTERPRETATION: A need exists to reevaluate the cost-effectiveness of a screening programme for glaucoma in Canada with updated efficacy and cost data. Health and monetary benefits could be improved compared with current practice and decision-makers would have the best available data when reevaluating the policy on screening for glaucoma.

Impact of visual impairment on service and device use by individuals with age-related macular degeneration (AMD).

PURPOSE: To assess the patient-reported use of services, supplements, and devices among individuals with age-related macular degeneration (AMD) and evaluate the impact of visual impairment level on this use. METHOD: Data for this study were collected using two instruments, the AMD Health and Impact Questionnaire and the Daily Living Tasks Dependent on Vision questionnaire (DLTV). Both questionnaires were mailed to members of the Macular Degeneration Partnership. The study was approved by an IRB and respondents provided consent before participating. Respondents' visual acuity (VA) was estimated using scores from the DLTV, while use of services and devices was collected from the AMD Questionnaire. De-identified data were analysed in SAS. RESULTS: Of 803 respondents, 56% were male and the mean age was 73 years. Use of services (e.g., counseling, rehabilitation), and devices significantly increased as VA decreased. Using standard US costs, costs for services, supplements, and devices ranged from 506-1619 US dollars depending on VA. CONCLUSION: There are substantial differences in service and device use with increased AMD severity. Delaying progression of AMD could result in considerable cost savings.

Treatment costs of cystoid macular edema among patients following cataract surgery.

PURPOSE: The current costs of treating cystoid macular edema (CME), a complication that can follow cataract surgery, are largely unknown. This analysis estimates the treatment costs for CME based on the recently released US Medicare data. SETTING: Nationally representative database. DESIGN: Retrospective analysis of the 2011 through 2013 Medicare 5% Beneficiary Encrypted Files. METHODS: Beneficiaries who underwent cataract surgery were identified and stratified by diagnosis of CME (cases) or no diagnosis of CME (controls) within 6 months following surgery. Claims and reimbursements for ophthalmic care were identified. Subgroup analyses explored the rates of CME in beneficiaries based on the presence of selected comorbidities and by the type of procedure (standard vs complex). Total Medicare and ophthalmic costs for cases and controls are presented. The analysis explored the effect of considering diabetic macular edema (DME) and macular edema (ME) as exclusion criteria. RESULTS: Of 78,949 beneficiaries with cataract surgery, 2.54% (n=2,003) were diagnosed with CME. One-third of beneficiaries had one or more conditions affecting retinal health (including diabetes), 4.5% of whom developed CME. The rate of CME, at 22.5%, was much higher for those patients with preoperative DME or ME. Ophthalmic charges were almost twice as high for cases compared with controls (US$10,410 vs $5,950); payments averaged 85% higher ($2,720 vs $1,470) (both P<0.0001). CONCLUSION: Substantial costs can be associated with CME; beneficiaries whose retinas are already compromised before cataract surgery face higher risk. Cost savings could be realized with the use of therapies that reduce the risk of developing CME. Future analyses could identify whether and to what extent comorbidities influence costs.