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Editors Selection IGR 16-3

Medical treatment: Treatment variations

Comment by Ivan Goldberg on:

13132 Variations in treatment among adult-onset open-angle glaucoma patients, Friedman DS; Nordstrom B; Mozaffari E et al., Ophthalmology, 2005; 112: 1494-1499

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From a research data set derived from a large United States health care provider (over 300,000 doctors caring for more than 14 million members over four geographic areas), Friedman et al. (1007) obtained billing records to assess current eye care provider (both ophthalmologist and optometrist) and patient behaviours in glaucoma management. They linked pharmacy and patient care information to detail the use of diagnostic and monitoring tests as well as treatment (medical, laser and/or surgery) among individuals newly diagnosed as glaucoma suspects or sufferers.

Using a logistic regression function adjusted for several factors, the results showed that women were more likely than men to seek consultations (57.5% versus 42.5%) and to have diagnosed glaucoma (52.3% versus 47.7%), yet 24% (odds ratio, 0.76, 95% confidence intervals 0.71-0.80) less likely to receive any form of treatment. Women were as likely as men to have optic nerve head imaging and visual field assessments. Other factors associated with a greater chance of any treatment were definite glaucoma diagnosis (compared with suspect status), older age, geographical region and longer follow-up.

Women are less likely to receive any form of treatment

What does this mean? As the authors state, in other areas of medicine, women have been reported to be less likely than men to undergo invasive procedures or to receive medications for cardiac disease, to have lower treatment rates in intensive care units and to have less frequent carotid endarterectomies. In Ophthalmology, Medicare patient reviews have reported African-Americans to have lower rates of glaucoma treatment or surgery than would be expected, and lower rates of cataract extraction.

These results need to be interpreted cautiously: this patient cohort is younger (mean age 51.3 years, less than 10% over 65) than the average US glaucoma population (65% over 65 years) and the data relies solely on billing codes.

Highlighting the use of large data bases (35,754 glaucoma suspects, 5265 definite glaucoma diagnoses, 2633 'optic disc cupping'), these results reveal significant variability in glaucoma treatment. As the authors conclude, "understanding the sources of this variation will help [achieve] better management strategies for individuals with glaucoma and suspect glaucoma."

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