About one in three older Americans diagnosed with primary open-angle glaucoma (POAG) are left untreated, according to a study presented at this years Association for Research in Vision and Ophthalmology (ARVO) meeting.

Researchers from Duke University, in Durham, N.C., analyzed data from the Medicare Current Beneficiary Survey (MCBS), which uses face-to-face interviews to determine the type and dosage of glaucoma medication Medicare beneficiaries used in the preceding year. Specifically, they used MCBS data from 1992 to 2002 merged with Medicare claims to determine rates of medical and surgical treatment for individuals aged 65 years and older, and to identify trends.

The MCBS identified 3,020 participants who had POAG. During each year of the study period, about 30% of beneficiaries with POAG did not receive medical or surgical treatment. Potential contributing factors include lack of access to care, clinicians and/or patients underestimating the importance of treatment, and the cost of medications.

Additional follow-up studies are needed to learn whether these and/or other factors help explain why so many patients go untreated, says lead researcher Joshua D. Stein, M.D., M.S.

Because the sample consisted only of Medicare beneficiaries, insurance coverage was not an issue. Yet, during our observational period, Medicare did not cover drugs used on an ambulatory basis. In this sense, finances could be a factor, says Frank A. Sloan, Ph.D., another of the researchers. Also, there are co-pays under Medicare Part B, which may be a barrier to some in obtaining visits; but this is probably a secondary factor.

In another study, the same researchers found that elderly patients with diabetic retinopathy and age-related macular degeneration also did not get recommended eye care. One factor was costs other than medical care cost, Dr. Sloan says. If one is disabled and living alone and/or lacks transportation, this is a barrier.

The results of the study presented at ARVO emphasize the importance of educating patients, physicians, health policymakers and insurance industry leaders about the benefits of consistent glaucoma therapy, the researchers conclude.

The importance of effective communication between the provider and the patient is key, Dr. Stein says. Patients need to understand the nature of this insidious disease process and how glaucoma medications often do not have noticeable effects in the short term, but that over time (as many trials have demonstrated) keeping IOP controlled prevents glaucoma progression and vision loss.

Dr. Sloan also recommends that clinicians have frank discussions with patients about what they perceive as barriers to care, and discuss potential solutions.

Stein JD, Sloan FA, Lee PP. Rates of glaucoma medication utilization among persons with primary open angle glaucoma, 1992-2002: Findings from the Medicare current beneficiaries survey. Paper presented at the Association for Research in Vision and Ophthalmology 2007 Annual Meeting, May 7, 2007; Fort Lauderdale, Fla. Abstract 1559.

Vol. No: 144:07Issue: 7/15/2007