title: Optic nerve complex imaging in glaucoma Medicare beneficiaries.
abstract: OBJECTIVE
  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.
authors: Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA.
authors: Lakshmi
authors: L
authors: Swamy
authors: Scott
authors: S
authors: Smith
authors: Nathan M
authors: NM
authors: Radcliffe
mesh_terms: D016208:Databases, Factual; D003941:Diagnostic Techniques, Ophthalmological; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014481:United States