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Visual field testing in glaucoma Medicare beneficiaries before surgery.

Anne L Coleman1, Fei Yu, Susannah Rowe

  • 1Jules Stein Eye Institute and the UCLA Department of Ophthalmology, Los Angeles, California 90095-7004, USA. coleman@jsei.ucla.edu

Ophthalmology
|March 5, 2005
PubMed
Summary

Ophthalmologists perform visual field (VF) testing before glaucoma surgery in only 70% of Medicare patients, falling short of the standard of care. This underutilization is more pronounced in older patients and Black individuals.

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Area of Science:

  • Ophthalmology
  • Public Health
  • Health Services Research

Background:

  • The standard of care for progressive glaucoma mandates annual visual field (VF) testing.
  • Glaucoma surgery is a significant intervention for managing advanced disease.

Purpose of the Study:

  • To evaluate the frequency of VF testing prior to glaucoma surgery in Medicare beneficiaries.
  • To identify demographic and clinical factors associated with variations in preoperative VF testing.

Main Methods:

  • Retrospective, observational, population-based analysis of Medicare beneficiaries undergoing glaucoma surgery (1995-1999).
  • Analysis of a 5% random sample of Medicare beneficiaries.
  • Determination of the proportion of patients with at least one VF test in the year preceding surgery.

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Main Results:

  • Overall, 70% of patients had preoperative VF testing.
  • Significantly lower rates were observed in patients aged 85 and older (56%), Black patients (64%), and those with diabetic retinopathy (60%) or bilateral blindness (47%).
  • Statistical significance for disparities was P<0.001.

Conclusions:

  • Preoperative VF testing in Medicare glaucoma patients is suboptimal compared to recommended standards.
  • Underutilization of VF testing is particularly concerning in Black patients, who face higher glaucoma risks.
  • Quality improvement initiatives are necessary to ensure adequate preoperative evaluation for glaucoma surgery.