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Original Investigation |

Trends Over Time and Regional Variations in the Rate of Laser Trabeculoplasty in the Medicare Population

Henry D. Jampel, MD, MHS1; Sandra D. Cassard, ScD2; David S. Friedman, MD, PhD2; Nakul S. Shekhawat, MPH3,4; Julia Whiteside-de Vos, MD, MPH4; Harry A. Quigley, MD2; Emily W. Gower, PhD2,5,6
[+] Author Affiliations
1Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
3Vanderbilt University School of Medicine, Nashville, Tennessee
4Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
5Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
6Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina
JAMA Ophthalmol. 2014;132(6):685-690. doi:10.1001/jamaophthalmol.2014.369.
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Importance  Laser trabeculoplasty (LTP) is routinely used to treat open-angle glaucoma; hence, understanding variations in its use over time and region is important.

Objective  To determine trends over time and the regional variation in the performance of LTP.

Design, Setting, and Participants  Database analysis of a 5% random sample of all Medicare beneficiaries 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 through 2009.

Interventions  We counted unique claims with a Current Procedural Terminology code of 65855 (LTP) submitted by ophthalmologists, optometrists, ambulatory surgery centers, or outpatient hospitals by region for each year. We examined trends over time and regional variation in LTP rates in 9 large geographic regions.

Main Outcomes and Measures  Rate of LTP per 10 000 Medicare beneficiary person-years and per 10 000 diagnosed open-angle glaucoma (OAG) person-years.

Results  The LTP rates per 10 000 Medicare beneficiary person-years were 36.3, 60.1, and 53.5 for 2002, 2006, and 2009, respectively. The 65.6% increase between 2002 and 2006 and the 11.0% decrease between 2006 and 2009 were statistically significant (tests for linear trend, P = .009 and P < .001, respectively). Similarly, the LTP rate among Medicare beneficiaries with OAG increased from 507.9 per 10 000 person-years in 2002 to 824.3 per 10 000 person-years in 2006 (62.3% increase; P = .009) and then decreased to 741 per 10 000 person-years by 2009 (10.1% decrease; P = .004). The rates per 10 000 OAG person-years differed significantly by region, ranging from 314 in the East South-Central region to 607 in the East North-Central region in 2002 (93.2% higher; P < .001). A similar range of variation was observed in subsequent years.

Conclusions and Relevance  The rate of LTP for Medicare patients with OAG peaked in 2006 and then decreased through 2009. Nearly twice as many LTP procedures per Medicare beneficiary were performed in some regions compared with others throughout the period.

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Figure 1.
The 9 Large Geographic Regions

Regions include P (Pacific), MT (Mountain), WNC (West North-Central), WSC (West South-Central), ENC (East North-Central), ESC (East South-Central), SA (South Atlantic), MA (Mid-Atlantic), and NE (New England). Hawaii and Alaska are included in the P region.

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Figure 2.
Laser Trabeculoplasty (LTP) Rate per 10 000 Medicare Beneficiary Person-Years

Error bars denote 95% CIs.

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Figure 3.
Laser Trabeculoplasty (LTP) Rate per 10 000 Open-Angle Glaucoma (OAG) Person-Years

Error bars denote 95% CIs.

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Figure 4.
Rates of Laser Trabeculoplasty

A, Rates of laser trabeculoplasty (LTP) per (A) open-angle glaucoma (OAG) patient and (B) Medicare beneficiary by large geographic region over time. For abbreviations, see Figure 1.

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