Coleman Anne L, Yu Fei, Rowe Susannah
Jules Stein Eye Institute and the UCLA Department of Ophthalmology, Los Angeles, California 90095-7004, USA.
Ophthalmology. 2005 Mar;112(3):401-6. doi: 10.1016/j.ophtha.2004.09.034.
The standard of care for progressive glaucoma that requires medical or surgical intervention includes visual field (VF) testing at least annually. This study aims to assess how commonly ophthalmologists perform VF testing before planned glaucoma surgery in the Medicare population, and whether variations in conformance occur across demographic and clinical subgroups.
Retrospective, observational, population-based analysis.
Thirteen thousand seven hundred fifty-three Medicare beneficiaries.
Data were obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States from 1995 to 1999. The proportion of patients with evidence of at least 1 VF examination in the year before glaucoma surgery was determined.
Rate of VF testing in the year before glaucoma surgery.
Overall, 70% of patients had at least 1 VF test in the year preceding glaucoma surgery. This rate was significantly lower (P<0.001) in patients > or =85 years (56%), blacks (64%), patients with race other than white or black (66%), patients with diabetic retinopathy (60%), and patients with bilateral blindness (47%).
The use of VF testing before surgery in glaucoma Medicare beneficiaries is suboptimal relative to the recommended standard of care. Underutilization is of particular concern in blacks, who are at increased risk of glaucomatous damage. Quality-of-care initiatives are needed to facilitate appropriate preoperative evaluations of glaucoma Medicare beneficiaries for glaucoma surgery.
对于需要药物或手术干预的进行性青光眼，护理标准包括至少每年进行一次视野（VF）检测。本研究旨在评估眼科医生在医疗保险人群中计划进行青光眼手术前进行VF检测的频率，以及在不同人口统计学和临床亚组中符合率是否存在差异。
回顾性、观察性、基于人群的分析。
13753名医疗保险受益人。
数据来自1995年至1999年在美国接受青光眼手术的5%医疗保险受益人的随机样本。确定在青光眼手术前一年有至少1次VF检查证据的患者比例。
青光眼手术前一年的VF检测率。
总体而言，70%的患者在青光眼手术前一年至少进行了1次VF检测。在85岁及以上患者（56%）、黑人（64%）、非白种人或黑种人的其他种族患者（66%）、糖尿病视网膜病变患者（60%）和双侧失明患者（47%）中，该比例显著较低（P<0.001）。
相对于推荐的护理标准，医疗保险青光眼受益人在手术前进行VF检测的情况并不理想。在青光眼损害风险增加的黑人中，检测利用不足尤其令人担忧。需要开展护理质量改进措施，以促进对医疗保险青光眼受益人进行适当的青光眼手术术前评估。
