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

Abstract

Précis: 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.