Lee Jun Hui, Yoo Kristy, Lung Khristina, Apolo Galo, Toy Brian, Sanvicente Carina, Xu Benjamin
From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California.
Keck School of Medicine at the University of Southern California (K.Y.), Los Angeles, California.
Am J Ophthalmol. 2024 Aug;264:90-98. doi: 10.1016/j.ajo.2024.02.032. Epub 2024 Feb 27.
To assess patterns in gonioscopy during initial glaucoma evaluations in the United States.
Retrospective, case-control study.
Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural Terminology (CPT) codes.
Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower (P < .001) among non-Hispanic Whites (OR=0.84) but similar for Blacks (OR=1.02) and Hispanics (OR=0.96) compared with Asians. Age ≥60 years (OR<0.82), pseudophakia/aphakia (OR=0.58), or residence outside of the Northeast region (OR=0.66-0.84) conferred lower odds of recorded gonioscopy (P < .001). Angle closure glaucoma (OR=0.85), secondary glaucoma (OR=0.31), or open angle glaucoma/suspect (OR=0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients (P < .01).
More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in non-Northeast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes.
评估美国青光眼初次评估时前房角镜检查的模式。
回顾性病例对照研究。
在Optum临床信息数据集市中识别出2009年至2020年间接受青光眼初次评估的患者。初次评估定义如下：（1）由眼科医生诊断为青光眼可疑、解剖性窄房角（ANA）或原发性/继发性青光眼；（2）在36个月的回顾期内可连续观察到；（3）无青光眼药物、激光或手术治疗史；（4）在初次诊断后6个月内进行了光学相干断层扫描（OCT）或视野检查。基于当前程序术语（CPT）编码建立逻辑回归模型，以识别与无前房角镜检查记录相关的因素。
在198,995例患者中，分别有20.4%和29.5%在诊断当天或6个月内有前房角镜检查记录。在多变量分析中，与亚洲人相比，非西班牙裔白人在初次评估后6个月内有前房角镜检查记录的几率较低（P < 0.001）（OR = 0.84），但黑人（OR = 1.02）和西班牙裔（OR = 0.96）的几率相似。年龄≥60岁（OR < 0.82）、人工晶状体/无晶状体（OR = 0.58）或居住在东北地区以外（OR = 0.66 - 0.84）的患者有前房角镜检查记录的几率较低（P < 0.001）。与ANA患者相比，闭角型青光眼（OR = 0.85）、继发性青光眼（OR = 0.31）或开角型青光眼/可疑患者（分别为OR = 0.12/0.24）进行前房角镜检查记录的可能性较小（P < 0.01）。
在美国，超过70%接受青光眼初次评估的患者无前房角镜检查记录，尤其是东北地区以外的老年、非西班牙裔白人及人工晶状体植入患者。这种模式不符合当前的实践指南，可能导致疾病误诊和治疗效果不佳。
