Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012.

PURPOSE: Determine how procedural treatments for glaucoma have changed between 1994-2012. DESIGN: Retrospective, observational analysis. PARTICIPANTS: Medicare Part B beneficiaries. METHODS: We analyzed Medicare fee-for-service paid claims data between 1994-2012 to determine the number of surgical/laser procedures performed for glaucoma in the Medicare population each year. MAIN OUTCOME MEASURES: Number of glaucoma-related procedures performed. RESULTS: Trabeculectomies in eyes without previous scarring decreased 52% from 54 224 in 1994 to 25 758 in 2003, and a further 52% to 12 279 in 2012. Trabeculectomies in eyes with scarring ranged from 9054 to 13 604 between 1994-2003, but then decreased 48% from 11 018 to 5728 between 2003-2012. Mini-shunts done via an external approach (including ExPRESS [Alcon Inc, Fort Worth, TX]) 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 a further 54% to 12 021 in 2012. Total cyclophotocoagulation procedures increased 253% from 2582 in 1994 to 9106 in 2003, and a further 54% to 13 996 in 2012. Transscleral cyclophotocoagulations decreased 45% from 5978 to 3268 between 2005-2012; 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, but since 2005 the number of trabeculoplasties decreased 19% to 142 682 in 2012. The number of laser iridotomies was fairly consistent between 1994-2012, increasing 9% over this period and ranging from 63 773 to 85 426. Canaloplasties increased 1407% from 161 in 2007 to 2426 in 2012. Between 1994-2012, despite a 9% increase in beneficiaries, the total number of glaucoma procedures and the number of glaucoma procedures other than laser procedures decreased 16% and 31%, respectively. CONCLUSIONS: Despite the increase in beneficiaries, the number of glaucoma procedures performed decreased. Glaucoma procedures demonstrating a significant increase in use include canaloplasty, mini-shunts (external approach), aqueous shunt to extraocular reservoir, and ECP. Trabeculectomy use continued its long-term downward trend. The continued movement away from trabeculectomy and toward alternative intraocular pressure-lowering procedures highlights the need for well-designed clinical trials comparing these procedures.

Macroeconomic landscape of refractive surgery in the United States.

PURPOSE OF REVIEW: This review examines the economic history of refractive surgery and the decline of laser-assisted in-situ keratomileusis (LASIK) in the USA, and the emergence of refractive cataract surgery as an area of growth. RECENT FINDINGS: Since it peaked in 2007 at 1.4 million procedures per year, LASIK has declined 50% in the USA, whereas refractive cataract surgery, including presbyopia-correcting intraocular lenses (IOLs), astigmatism-correcting IOLs, and femtosecond laser-assisted cataract surgery, has grown to 350 000 procedures per year, beginning in 2003. SUMMARY: Patients are price-sensitive and responsive to publicity (good or bad) about refractive surgery and refractive cataract surgery. LASIK's decline has been partially offset by the emergence of refractive cataract surgery. About 11% of all cataract surgery in the USA involves presbyopia-correcting IOLs, astigmatism-correcting IOLs, or a femtosecond laser. From the surgeon's perspective, there are high barriers to entry into the marketplace for refractive surgery and refractive cataract surgery due to the high capital cost of excimer and femtosecond lasers, the high skill level required to deliver spectacular results to demanding patients who pay out of pocket, and the necessity to perform a high volume of surgeries to satisfy both of these requirements. Probably, less than 7% of US cataract surgeons can readily meet all of these requirements.

Changes in Performance of Glaucoma Surgeries 1994 through 2017 Based on Claims and Payment Data for United States Medicare Beneficiaries.

PURPOSE: To evaluate trends in glaucoma procedures in the United States Medicare population and to evaluate which physicians are performing newer procedures. DESIGN: Analysis of publicly available claims and payment data. PARTICIPANTS: Surgeons and beneficiaries enrolled in United States Medicare between 1994 and 2017. METHODS: Data regarding payments to physicians by the Centers for Medicare and Medicaid Services (CMS) were downloaded for the years 2012 through 2017. Data regarding claims to CMS by physicians were requested and processed between 1994 and 2017. Procedure counts from both data sets then were normalized for changes in the Medicare population, with 1995 as the baseline. The normalized volumes of procedures over time were visualized, as were geographic distributions of surgeons and their volume of procedures. MAIN OUTCOME MEASURES: Trends in procedure counts over time, geographic distribution of surgeons, and their volume of procedures. RESULTS: The number of trabeculectomies continues to decline and now is similar to the number of tubes. Use of the relatively new trabecular bypass shunts has increased rapidly. Surgeons performing these procedures are less likely to be performing traditional glaucoma surgeries as well. The number of laser-based cyclodestruction procedures increased after introduction of the endoscopic technique and again with the introduction of so-called micropulse procedures. The procedure counts obtained with physician payment data consistently are lower than those from claims data given the limitations of the payment data. CONCLUSIONS: Glaucoma practice patterns change each time a new device or procedure is introduced. Collectively, the use of new microinvasive glaucoma surgery procedures has increased rapidly such that they now account for a significant majority of glaucoma surgeries. Given the almost complete lack of comparative data to inform surgeon choices regarding these procedures, it will be important that randomized studies are carried out to fill this gap.

Tissue oxygenation monitoring in the field: a new EMS vital sign.

BACKGROUND: A tissue hemoglobin oxygen saturation (STO2) monitor was created to assess the perfusion status of a peripheral muscle bed using near infrared light to directly measure oxygen saturation in the microcirculation. Hypoperfusion has been noted when the STO2 is <75%. The use of this technology has not been tested in the prehospital setting. This pilot study was performed to assess the technology's ease of use in the field and to correlate STO2 readings with patient outcomes. METHODS: Hospital-based transport vehicles were equipped with STO2 monitors and personnel were asked to evaluate the functionality of the technology. Initial, average, and minimal STO2 values were collected and compared with data of the trauma registry. RESULTS: Forty five of 55 surveys were returned with 100% reporting ease of use and no reports of interference with monitors or avionics. Monitoring length averaged 16.9 minutes +/- 6.9 minutes. Forty-one patients had complete data sets and five deaths were reported for a mortality rate of 12%. STO2 endpoints revealed and increased risk of death for every 10% decrease in STO2. CONCLUSION: The STO2 monitor can easily be used in the prehospital environment. In addition, initial recordings were significantly different between survivors and nonsurvivors with every 10% decrease in STO2 increasing mortality threefold. This monitor seems to give the prehospital provider a noninvasive tool for assessment of hypoperfusion in the field and may allow for earlier resuscitative efforts to commence.

Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004.

OBJECTIVE: To observe how the treatment of glaucoma has changed over the last decade. DESIGN: Retrospective, observational, population-based analysis. PARTICIPANTS: Medicare beneficiaries between 1995 and 2004. METHODS: Medicare fee-for-service data claims between 1995 and 2004 were analyzed to determine the number of penetrating surgeries and laser procedures performed for glaucoma in the decade spanning 1995 and 2004. MAIN OUTCOME MEASURE: Number of Medicare beneficiaries receiving glaucoma-related laser procedures or surgery. RESULTS: Trabeculectomies in eyes without previous surgery or trauma decreased 53% over the study period, from 51,690 in 1995 to 24,178 in 2004, although trabeculectomy in eyes with scarring increased 9%. The number of aqueous shunting devices placed rose 184%, from 2728 in 1995 to 7744 in 2004. Cyclophotocoagulation procedures rose 248% over the study period, from 3264 procedures in 1995 to 11,356 procedures in 2004. Between 1995 and 2001, the number of laser trabeculoplasties decreased 57%, from a high of 151,244 in 1995 to a low of 75,647 in 2001. From 2001 to 2004, the number of trabeculoplasties more than doubled, with 157,490 performed in 2004. The number of laser iridotomies showed little fluctuation, increasing 18% over the study period and ranging from 63,773 to 85,286 every year. Over the study period, surgical iridectomies, including peripheral and sector iridectomies, decreased 66%, from a total of 4842 in 1995 to 1654 in 2004. Fistulization procedures other than trabeculectomy (including the Scheie and Holt procedures and iridencleisis) dropped 83% over the study period, decreasing from 2833 in 1995 to 478 in 2004. CONCLUSIONS: Medicare recipients with glaucoma are more likely to be treated with aqueous shunting procedures or cyclophotocoagulation and less likely to be treated with trabeculectomy, compared with past years. After a decline in use between 1995 and 2001, laser trabeculoplasty increased substantially from 2001 to 2004. Fistulization procedures other than trabeculectomy and surgical iridectomy have become very uncommon.

Alcohol use, cognitive correlates of drinking and change readiness in hazardous drinkers with high versus low social anxiety.

OBJECTIVE: Prevalence data and theoretical models suggest that socially anxious individuals comprise a significant subset of college hazardous drinkers and may benefit from brief interventions for both alcohol and social anxiety problems. The present study compared hazardous drinkers who have high social anxiety (HD-HSA) with hazardous drinkers who have low social anxiety (HD-LSA) in drinking and psychological characteristics that may distinguish the two drinker groups and inform development of group-specific interventions. METHOD: After completing a self-report assessment battery, 152 hazardous drinkers (51% men, median age = 19) were selected from an undergraduate volunteer sample on the basis of their scores on an alcohol screen. HD-HSA (n = 76) and HD-LSA (n = 76) were hazardous drinkers who scored in the top third and the bottom third, respectively, of the volunteer sample on a social anxiety measure. RESULTS: HD-HSA reported greater expectancies that alcohol reduces social anxiety and lower alcohol refusal self-efficacy in social drinking situations than HD-LSA did. HD-HSA also tended to report more frequent heavy drinking in negative affect situations, but the groups did not differ in consumption quantity, heavy drinking in positive affect situations or hazardous drinking levels. HD-HSA reported greater interest in attending a social anxiety workshop and showed a trend towards having stronger interest in an alcohol workshop than HD-LSA did, although the sample's overall readiness to change alcohol behaviors was low. CONCLUSIONS: Study findings highlight the importance of situational specificity in alcohol assessment and suggest a need to develop group-specific interventions for college hazardous drinkers with high versus low social anxiety.

Bulimic symptoms and mood predict food relevant Stroop interference in women with troubled eating patterns.

Cognitive processing differences based on attentional biases of words pertaining to eating disorders were investigated to assess people's pathological thoughts. Participants were 165 undergraduate women (mean age=19.2) at a large Midwestern university. This Stroop task that included color identification of three word groups (food-related words, neutral words, and color words) was administered to measure differential speed in cognitive processing of salient words in individuals with and without troubled eating patterns. As predicted by the moderator hypothesis, a statistically significant interaction effect between bulimic symptoms and negative mood was found on food-related reaction time. Post hoc analysis of the interaction showed that women endorsing more bulimic symptoms responded slower to food-related cues than women with fewer bulimic symptoms among individuals who reported negative mood. The study results indicate that women who have problematic eating patterns and experience negative mood are hyperattentive to food-related cues.

Incidence of chaotic eating behaviors in binge-eating disorder: contributing factors.

Because dieting is not as common in patients with binge-eating disorder (BED) as among patients with bulimia or anorexia nervosa, the authors assessed the incidence, frequency, and contributing factors of semistarvation-like eating patterns in BED patients in this study, the first to explore such behaviors in a clinical population. They administered the Semistarvation-Associated Behaviors Scale (SSABS) to 54 women seeking BED treatment and to 29 controls. The aberrant eating behaviors among BED clients were associated with current dieting and certain BED criteria, (p < .05). The strongest contributor to chaotic eating patterns was negative affect preceding BED (r = .45, p < .001). This finding highlights the behavioral psychopathology of BED and strengthens the role of negative affect in precipitating binge episodes associated with the disorder. These behaviors may help maintain BED by creating a binge-negative affect cycle. The SSABS is a tool that may help break this cycle.

Use of retinal procedures in medicare beneficiaries from 1997 to 2007.

OBJECTIVE: To observe how the treatment of retinal conditions changed over the preceding decade. METHODS: Medicare fee-for-service data claims filed between 1997 and 2007 were analyzed. RESULTS: Fewer than 5000 intravitreal injections of a pharmacological agent were performed annually between 1997 and 2001. Thereafter, the annual number of intravitreal injections more than doubled every year through 2006, reaching a high of 812,413 in 2007. Photodynamic therapy procedures decreased 83% from a peak of 133,565 procedures in 2004 to 22,675 procedures in 2007, while laser treatment of choroidal lesions or neovascularization decreased 83% from a peak of 82,089 in 1999 to a minimum of 13,821 in 2007. Vitrectomies for primary retinal detachment (with or without scleral buckling) increased 72% over the study period from 11,212 in 1997 to 19,923 in 2007, while scleral buckles performed without vitrectomy decreased 69% from 8691 to 2660. Substantial volume increases were also observed for vitrectomy with retinal membrane stripping (90% increase from 29,426 in 1997 to 56,051 in 2007) or endolaser panretinal photocoagulation (86% increase from 10,319 in 1997 to 19,154 in 2007). Volumes of pneumatic retinopexy, laser prophylaxis for retinal detachment, laser treatment for retinal edema, and laser treatment for retinopathy all changed less than 25% from 1997 and 2007. CONCLUSIONS: Marked changes in the use of several retinal procedures occurred between 1997 and 2007, particularly in the treatment of macular degeneration and retinal detachment. These changes point to greater acceptance and incorporation of vitrectomy and intravitreal injection as treatment modalities.

Perceptions and metaperceptions of same-sex social interactions in college women with disordered eating patterns.

This study compared perceptions and metaperceptions after a social interaction between a woman with disordered eating (subclinical bulimia nervosa) and a female interaction partner. Hypotheses were: women with disordered eating would have more negative metaperceptions of social interactions than women without disordered eating, and women with disordered eating would show a greater discrepancy between metaperceptions and perceptions than women without disordered eating. All participants completed questionnaires about their perceptions and metaperceptions post-interaction. Results showed women with disordered eating thought that they had made a negative impression; findings addressing the relationships among social desirability, loneliness, social support utilization, and fear of negative evaluation are also discussed.

Target acquisition with UAVs: vigilance displays and advanced cuing interfaces.

Vigilance and threat detection are critical human factors considerations in the control of unmanned aerial vehicles (UAVs). Utilizing a vigilance task in which threat detections (critical signals) led observers to perform a subsequent manual target acquisition task, this study provides information that might have important implications for both of these considerations in the design of future UAV systems. A sensory display format resulted in more threat detections, fewer false alarms, and faster target acquisition times and imposed a lighter workload than did a cognitive display format. Additionally, advanced visual, spatial-audio, and haptic cuing interfaces enhanced acquisition performance over no cuing in the target acquisition phase of the task, and they did so to a similar degree. Thus, in terms of potential applications, this research suggests that a sensory format may be the best display format for threat detection by future UAV operators, that advanced cuing interfaces may prove useful in future UAV systems, and that these interfaces are functionally interchangeable.