Visual field testing in glaucoma Medicare beneficiaries before surgery.
OBJECTIVE
The standard of care for progressive glaucoma that requires medical or surgical intervention includes visual field (VF) testing at least annually. This study aims to assess how commonly ophthalmologists perform VF testing before planned glaucoma surgery in the Medicare population, and whether variations in conformance occur across demographic and clinical subgroups.


METHODS
Retrospective, observational, population-based analysis.


METHODS
Thirteen thousand seven hundred fifty-three Medicare beneficiaries.


METHODS
Data were obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States from 1995 to 1999. The proportion of patients with evidence of at least 1 VF examination in the year before glaucoma surgery was determined.


METHODS
Rate of VF testing in the year before glaucoma surgery.


RESULTS
Overall, 70% of patients had at least 1 VF test in the year preceding glaucoma surgery. This rate was significantly lower (P<0.001) in patients > or =85 years (56%), blacks (64%), patients with race other than white or black (66%), patients with diabetic retinopathy (60%), and patients with bilateral blindness (47%).


CONCLUSIONS
The use of VF testing before surgery in glaucoma Medicare beneficiaries is suboptimal relative to the recommended standard of care. Underutilization is of particular concern in blacks, who are at increased risk of glaucomatous damage. Quality-of-care initiatives are needed to facilitate appropriate preoperative evaluations of glaucoma Medicare beneficiaries for glaucoma surgery.
Coleman
Anne L
AL
Jules Stein Eye Institute and the UCLA Department of Ophthalmology, Los Angeles, California 90095-7004, USA. coleman@jsei.ucla.edu
Yu
Fei
F
Rowe
Susannah
S
D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S.; D003695:Delivery of Health Care / Q000592:standards; D005006:Ethnicity; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000208:ethnology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014130:Trabeculectomy; D014481:United States; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests / Q000706:statistics & numerical data*; D014794:Visual Fields