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Editors Selection IGR 13-4

Health Economics: Impact of technological progress and demographic change on eyecare

Comment by Franz Grehn on:

55519 Increase in examinations for cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration : Comparative cross-sectional study between 2010 and 1997 in ophthalmological practices, Bertram B; Gante C; Hilgers RD, Ophthalmologe, 2014; 111: 757-764

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This paper describes frequency of diagnosis of four major ophthalmic diseases in a representative sample of ophthalmic practices in Germany in 1997 versus 2010, taking into account the demographic changes during this period. The four leading diagnoses were: cataract, glaucoma, diabetic retinopathy, and macular degeneration/vitreoretinal disease.

The comparison was made between a previous study of 19,047 patients from 106 ophthalmologists in 1997 versus a representative sample of 15,125 patients of 96 ophthalmologists in 2010. The proportion of patients of age ≥ 70 years treated in these practices increased from 25.3% in 1997 to 40.8% in 2010 (relative increase 61.3%). The proportion of glaucoma care in the 1997 sample was 16.0%, and in the 2010 sample 18.9% of all diagnoses, respectively (cataract 11.9% vs 14.9%, Diabetes 6.2% vs 9.5%, and AMD/vitreoretinal disease 4,3% vs 6.7%).

Glaucoma patients of the 2010 sample were seen 5.2 times per year in these ophthalmic practices. Imaging was performed in 7.6% and pachymetry in 3.4% of visits. For screening of glaucoma, 11.2 % of patients were seen.

This study of German ophthalmic care in 1997 versus 2010 shows that the number of examinations for glaucoma has significantly increased

This study of German ophthalmic care in 1997 versus 2010 shows that the number of examinations for glaucoma has significantly increased. Even when adjusted for demographic change, the increase is considerable. The absolute number of glaucoma patients in Germany is estimated to be 1 Mio (total population 81 Mio). The estimated number of screening examination for glaucoma in 2010 is 4 Mio. The relative increase may have several sources beyond demographic change: (1) The awareness for glaucoma in the population has increased; (2) The decrease of refund for a comprehensive ophthalmic examination has pushed the system towards extra-paid examinations such as screening packages, imaging, pachymetry etc.; (3) The threshold for following and treating glaucoma patients has been reduced due to several factors (medicolegal, financial, technical etc.); (4) The use of standard imaging techniques for the diagnosis of glaucoma has increased the number of borderline diagnoses that have to be followed.

In summary, this overview illustrates the challenge of an increasing need for glaucoma care due to demographic changes as well as an increment of glaucoma follow up due to modern technology and screening.

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