Changes in glaucoma management following visual field testing and optical coherence tomography.

Area of Science:

• Ophthalmology
• Medical Diagnostics
• Health Services Research

Background:

• The optimal use of diagnostic investigations in glaucoma management is not well-defined.
• There is a need to understand the relationship between diagnostic testing and subsequent treatment adjustments in glaucoma care.

Purpose of the Study:

• To investigate the temporal association between diagnostic testing (Humphrey visual field and optical coherence tomography) and management changes in glaucoma patients.
• To determine if specific investigations correlate with different types of management interventions.

Main Methods:

• A retrospective observational study analyzed nationwide healthcare insurance claims data from 2003 to 2020.
• Glaucoma outpatient encounters for patients aged 40 years and older were identified, noting the performance of Humphrey visual field (HVF) and/or optical coherence tomography (OCT).
• Management changes, including surgery, laser trabeculoplasty (LT), or medication adjustments, were tracked within defined timeframes following encounters.

Main Results:

• Over 12.6 million encounters were analyzed; HVF and OCT were performed in 32.8% and 22.2% of visits, respectively.
• Encounters with HVF and/or OCT showed a 49% increased likelihood of a subsequent management change compared to encounters without investigations (p<0.001).
• HVF was more strongly associated with subsequent surgery and LT, whereas both HVF and OCT were linked to higher odds of medication changes.

Conclusions:

• Glaucoma management changes occurred after approximately 5% of outpatient encounters.
• Humphrey visual field testing was more frequently associated with subsequent surgical or laser interventions compared to optical coherence tomography.
• Both diagnostic investigations were associated with an increased likelihood of medication adjustments in glaucoma management.