Glaucoma management among individuals enrolled in a single comprehensive insurance plan

Objective: To determine the management patterns for glaucoma and suspect glaucoma in a nationally representative sample of newly treated persons. Design: Retrospective cohort study of persons enrolled in a large managed care organization. Participants: One thousand seven hundred twelve diagnosed suspects and 3623 diagnosed glaucoma patients. Methods: Linked pharmacy and patient care data were used to examine the glaucoma management and treatment patterns in this cohort of persons insured by a single managed care organization. Rates of monitoring and treatment were calculated for the 3 study groups. Main Outcome Measures: Probability of monitoring (return visits, visual fields [VFs], and optic nerve head imaging or photography) and treatment (argon laser trabeculoplasty [ALI] and surgery) for newly treated persons with suspect and glaucoma diagnoses. Results: After a median follow-up of 440 days, 83% of treated diagnosed suspects had had a billed follow-up office visit to either an optometrist or an ophthalmologist at any time during follow-up, 46% had had at least one billed VF, and 13% had had some form of optic nerve head imaging. Rates were slightly higher for those with diagnosed glaucoma (P > 0.05). Surgery and ALT were performed rarely in this treated population (11%-6% at 2 years). Conclusions: This study suggests that a large proportion of individuals felt to require treatment for glaucoma or suspect glaucoma are falling out of care and are being monitored at rates lower than expected from recommendations of published guidelines. More research is needed to confirm these findings and to determine the reasons for loss to follow-up and low monitoring rates.