Department of Ophthalmology, University of Washington, Seattle.
Ophthalmology Section, Puget Sound Veterans Affairs Medical Center, Seattle, Washington.
JAMA Ophthalmol. 2018 Nov 1;136(11):1227-1234. doi: 10.1001/jamaophthalmol.2018.3463.
Glaucoma is a common cause of visual impairment in the Veterans Affairs (VA) health care system, but to our knowledge, no data exist concerning tertiary glaucoma care (ie, laser and filtering surgery).
To determine whether the rate of tertiary glaucoma care differs among veterans cared for through the 4 different eye care delivery models that are present in the VA: optometry-only clinics, ophthalmology-only clinics, clinics with optometry and ophthalmology functioning as a single integrated clinic with ophthalmology as the lead, and clinics with optometry and ophthalmology functioning as separate clinics.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective review of the Veterans Health Administration Support Service Center database, 490 926 veterans with a glaucoma-related diagnosis received care from 136 VA medical centers during fiscal year 2016. Demographic and baseline clinical factors, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology codes, and the rates of glaucoma surgery procedures were extracted from the database. The organizational structure of each VA eye clinic was obtained. Univariate and multivariate regression analyses were performed for log percent for laser peripheral iridotomy (LPI), laser trabeculoplasty (LTP), and filtering surgery.
Rates of LPI, LTP, and filtering surgery.
Of the 490 926 veterans with a glaucoma-related diagnosis, 465 842 (94.9%) were male, 309 677 (63.1%) were white, and 203 243 (41.4%) were aged 65 to 74 years. The rate of LPI was 0.30%, 0.28%, 0.67%, and 0.69% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of LTP was 0.31%, 1.06%, 0.93%, and 0.92% in care delivery models that included optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of filtering surgery was 0.32%, 0.51%, 0.69%, and 0.60% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). Multivariate regression analyses showed that these differences remained significantly different even after adjusting for potential confounders.
Disparities exist in the use of tertiary glaucoma services within the VA, and different care delivery models may play a role. Outcomes of glaucoma care for the different models of eye care delivery were not analyzed in this study.
青光眼是退伍军人事务部（VA）医疗保健系统中常见的视力损害原因，但据我们所知，关于三级青光眼治疗（即激光和过滤手术）尚无数据。
确定在 VA 中存在的 4 种不同眼科护理提供模式中，接受护理的退伍军人之间的三级青光眼治疗率是否存在差异：仅验光配镜诊所、仅眼科诊所、验光和眼科作为一个单一的综合诊所运作且以眼科为主导的诊所，以及验光和眼科作为独立诊所运作的诊所。
设计、地点和参与者：在这项对退伍军人健康管理支持服务中心数据库的回顾性研究中，2016 财年共有 490926 名患有与青光眼相关诊断的退伍军人在 136 个 VA 医疗中心接受治疗。从数据库中提取了人口统计学和基线临床因素、国际疾病分类和相关健康问题第十版和当前程序术语代码，以及青光眼手术程序的比率。获得了每个 VA 眼科诊所的组织结构。对激光周边虹膜切开术（LPI）、激光小梁成形术（LTP）和过滤手术的激光百分比进行了单变量和多变量回归分析。
LPI、LTP 和过滤手术的比率。
在 490926 名患有与青光眼相关诊断的退伍军人中，465842 名（94.9%）为男性，309677 名（63.1%）为白人，203243 名（41.4%）年龄在 65 至 74 岁之间。仅验光配镜诊所、仅眼科诊所、综合诊所和分离诊所的 LPI 率分别为 0.30%、0.28%、0.67%和 0.69%（P<0.001）。在包括仅验光配镜诊所、仅眼科诊所、综合诊所和分离诊所的护理提供模式中，LTP 率分别为 0.31%、1.06%、0.93%和 0.92%（P<0.001）。仅验光配镜诊所、仅眼科诊所、综合诊所和分离诊所的过滤手术率分别为 0.32%、0.51%、0.69%和 0.60%（P<0.001）。多变量回归分析表明，即使在调整了潜在混杂因素后，这些差异仍然存在显著差异。
VA 内部存在三级青光眼服务使用方面的差异，不同的护理提供模式可能发挥作用。本研究未分析不同眼科护理提供模式的青光眼护理结果。
