title: Reduced fluorescein angiography and fundus photography use in the management of neovascular macular degeneration and macular edema during the past decade.
abstract: OBJECTIVE
  We assessed recent trends in the use of diagnostic testing for neovascular age-related macular degeneration (NVAMD) and macular edema (ME).
  
  
  METHODS
  Claims data from a managed-care network were analyzed on patients with NVAMD (n = 22,954) or ME (n = 31,810) to assess the use of fluorescein angiography (FA), fundus photography (FP), and optical coherence tomography (OCT) from 2001 to 2009. Repeated-measures logistic regression was performed to compare patients' odds of undergoing these procedures in 2001, 2005, and 2009. In addition, the proportions of patients with an incident NVAMD or ME diagnosis in 2003 or 2008 who underwent FA, FP, and OCT were compared.
  
  
  RESULTS
  From 2001 to 2009, among patients with NVAMD, the odds of undergoing OCT increased 23-fold, whereas the odds of receiving FA and FP decreased by 68% and 79%, respectively. Similar trends were observed for ME. From 2003 to 2008, the proportion of patients undergoing OCT within 1 year of initial diagnosis increased by 315% for NVAMD and by 143% for ME; the proportion undergoing OCT without FA within 1 year increased by 463% for NVAMD and by 216% for ME.
  
  
  CONCLUSIONS
  Use of OCT increased dramatically during the past decade, whereas use of FA and FP declined considerably, suggesting that OCT may be replacing more traditional diagnostic testing in patients with NVAMD or ME. Future studies should evaluate whether this increased reliance on OCT instead of FA and FP affects patient outcomes.
authors.affiliation: Duke University Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schneider
authors.forename: Prithvi
authors.initials: P
authors.lastname: Mruthyunjaya
authors.forename: Nidhi
authors.initials: N
authors.lastname: Talwar
authors.forename: Kristen
authors.initials: K
authors.lastname: Harris Nwanyanwu
authors.forename: Bin
authors.initials: B
authors.lastname: Nan
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005544:Forecasting; D005654:Fundus Oculi; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis* / Q000209:etiology; D008269:Macular Edema / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015861:Retinal Neovascularization / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000706:statistics & numerical data*
keywords: age-related macular degeneration; fluorescein angiography; macular edema; optical coherence tomography; utilization