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Abstract
Purpose: To assess the frequency of fundus photography and scanning computerized ophthalmic diagnostic imaging (SCODI) on patients receiving glaucoma care under Medicare.
Methods: In this retrospective, observational, Medicare claims-based study, we used a 5% random sample, from 2006–2008, of Medicare beneficiaries, selected for International Classification of Diseases, 9th Revision (ICD-9) diagnoses of glaucoma or glaucoma suspect, who had greater than one year of follow up (N = 143,374). The proportion of patients with an ICD-9 diagnosis of glaucoma or glaucoma suspect who received fundus photography (Physicians’ Current Procedural Terminology, CPT 99250) or scanning computerized ophthalmic diagnostic imaging (SCODI; CPT 92135) was determined.
Results: A total of 48% of patients did not have any form of imaging during the study period. Among those who were imaged, 27% were imaged only once. The use of fundus photography was significantly lower than the use of SCODI (p < 0.00005). A total of 75% of those imaged once received SCODI while only 25% were photographed. Analysis of optic nerve complex imaging over time revealed that 20% received SCODI and 6% were photographed in the first quarter of appearance of the glaucoma or suspect diagnosis code in the dataset, with a decline thereafter.
Conclusions: Optic disc imaging in patients diagnosed with glaucoma or glaucoma suspect may not meet guidelines set by the American Academy of Ophthalmology. While both modalities are underused, optic disc photos are performed less often and repeated less frequently when compared to SCODI. Underuse of imaging may negatively impact detection of disease progression over time in glaucoma patients.
ACKNOWLEDGMENTS
The authors would like to thank Dan Caligor for helpful discussions and invaluable assistance with resources and statistics, and Susan White for extensive statistical work.
Declaration of interest: None of the authors have any proprietary interests or conflicts of interest related to this submission. Data for this study were made available to the authors by an unrestricted gift from EyeIC (Narberth, PA). NMR has served as a consultant and/or speaker for Ophthalmic Imaging Systems, Allergan, Inc., Alcon, and Carl Zeiss Meditec. LS was supported by the National Institutes of Health Medical Scientist Training Program Grant GM07739.