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.