National Utilization of Glaucoma Laser and Surgical Management in Medicare Beneficiaries: Disparities and Accessibility.

PRCIS: In this population-based, cross-sectional study of Medicare beneficiaries, there were lower odds of national glaucoma surgery among ages older than 85, female sex, Hispanic ethnicity, and diabetic comorbidity. Glaucoma surgery rates were independent of ophthalmologist distribution. PURPOSE: With an increasing prevalence of glaucoma in the United States, it is crucial to elucidate surgical procedure accessibility to deliver quality care. The objective of this study was to estimate national access to surgical glaucoma care by (1) comparing diagnostic and surgical management Medicare insurance claims followed by (2) correlating Medicare treatment claims with regional ophthalmologist availability. PATIENTS AND METHODS: This cross-sectional study included Medicare claims from the 2017 Vision and Eye Health Surveillance System and workforce data from the 2017 Area Health Resource Files, both public domain databases. A total of 25,443,400 beneficiaries fully enrolled in Medicare Part B Fee-for-Service with glaucoma diagnosis claims were included. Rates of US MD ophthalmologists were determined by Area Health Resource Files distribution densities. Surgical glaucoma management rates included Medicare service utilization claims for drain, laser, and incisional glaucoma surgery. RESULTS: While Black, non-Hispanic Americans had the highest prevalence of glaucoma, Hispanic beneficiaries had the highest odds of surgery. Older age (85+ vs. 65-84 y; Odds Ratio [OR]=0.864; 95% Confidence Interval [CI], 0.854-0.874), female sex (OR=0.923; 95% CI, 0.914-0.932), and having diabetes (OR=0.944; 95% CI, 0.936-0.953) was associated with lower odds of having a surgical glaucoma intervention. Glaucoma surgery rates were not associated with ophthalmologist density by state. CONCLUSIONS: Glaucoma surgery utilization differences by age, sex, race/ethnicity, and systemic comorbidities warrant further investigation. Glaucoma surgery rates are independent of ophthalmologist distribution by state.

Psychomotor vigilance and visual field test performance.

INTRODUCTION: Visual field test is an invaluable tool to evaluate the detection and progression of glaucoma. On the other hand, as a subjective test, reliable results depend on patients' optimum performance including vigilance during the test. The purpose of this study was to understand patient's attitude and preferences about the visual field test taking, and in addition to assess the relationship between the reliability indices of visual field testing (VFT) and the Walter Reed Psychomotor Vigilance Test (PVT). MATERIAL AND METHODS: In this cross-sectional, non-interventional study, VFT reliability indices were recorded for all 140 patients. In the 46 patients who completed the PVT, average reaction time and minimum reaction times were recorded. All 140 patients completed a survey about their VFT experience. RESULTS: Based on the survey results, most subjects found VFT to be difficult. Subjects who rated their VFT performance excellent/good had similar VFT reliability rates compared to the ones with fair/poor self-assessments. The average reaction time (RT) was 0.6 seconds (0.3-1.9 seconds). Higher average RT was associated with increased age and less formal education (p < 0.001 and 0.03, respectively). There was a marginally significant correlation between average RT and the VFT "reliability" status (p = 0.045). CONCLUSIONS: While VFT is the least favorable part of the work-up for glaucoma patients, their self-assessment about VFT performance did not correlate with current VF reliability indicators. Although reliability of the VFT was not strongly affected by slower reaction times when tested by the PVT, the effect of psychomotor reaction time on other aspects of test outcomes is unknown and warrants further investigation.

Optic disc and visual test findings in patients with migraine.

This study was conducted to determine whether the optic disc appearance and the visual field parameters of patients with migraine vary from those of age-matched controls. Twenty-two patients with migraine and 20 control participants were enrolled in the study. The automated visual field tests by Humphrey Field Analyzer® and optic disc images by Topcon® fundus camera were obtained from each participant. Horizontal and vertical cup-to-disc ratios were calculated by a manual, planimetric technique performed by two independent observers. The visual field indices including mean deviation (MD) and pattern standard deviations (PSD) were documented. No difference was found in the average cup-to-disc ratio between patients with migraine and control participants. However, MD and PSD of the groups were different. The average MD in the migraine group was -0.86+1.21, and in the control group was 0.10+1.03 (p=0.009). The average PSD in the migraine group was 2.11+0.68 and in the control group was 1.68+0.44 (p=0.024). In conclusion, this study demonstrated that patients with migraine had decreased sensitivity in their visual fields compared to the control participants.