Influence of Socio-Demographic Characteristics on Eye Care Expenditure: Data from the Medical Expenditure Panel Survey 2007

ABSTRACT

Objective: To evaluate the association between sociodemographic factors and eye care expenditure and to assess the burden of ocular expenditure compared to total health care expenditure.

Methods: A retrospective analysis of ocular expenditure in participants of the 2007 Medical Expenditure Panel Survey. Data from 20,620 unique participants aged ≥18 years were evaluated for eye care expenditure by demographic characteristics.

Results: A total of 22% of the studied population had eye care expenditures in 2007. Demographic factors significantly associated with higher probability of having eye care expenditures included older age (65+ years 35%, 45–64 years 23%, <45 years 17%), female sex (female 26%, male 19%), higher educational attainment (greater than high school education 25%, less than high school education 17%), having insurance (private 24%, uninsured 13%), and visual impairment (mild 31%, none 22%). Older age, female sex, higher educational attainment, having insurance, and presence of visual impairment were also significantly associated with higher mean eye care expenditure. In those with eye care expenditure, the mean ratio between eye care and total medical expenditure was 24%, with uninsured patients spending 42% of their medical care expenditure on eye care.

Conclusions: Demographic factors are associated with both the probability of having ocular expenditure and the amount of expenditure. Of all factors examined, insurance status has the most potential for modification. Policy makers should consider these numbers when devising the terms by which eye care coverage will be provided under the Patient Protection and Affordable Care Act.     

Prevalence and distribution of glaucoma in central India (Glaucoma Survey 2001)

PURPOSE: A community-based survey was conducted in Rajnandangaon district of Chhattisgarh state of central India in 2001 to assess the prevalence of glaucoma in the age group of =35 years. DESIGN: Community-based cross-sectional survey. MATERIALS AND METHODS: Ophthalmologists measured ocular pressure using Perkins applanation tonometer. Best corrected visual acuity was checked by ETDRS chart. After dilating the pupil the fundus was examined. A sketch diagram was drawn to note glaucomatous changes in optic disc and the surrounding retina. The field of vision was tested on Bjerrum screen. Gonioscopy was performed to determine type of glaucoma. Persons and their relatives were interviewed to find out risk factors and glaucoma treatment in the past. RESULTS: Seven thousand four hundred and thirty-eight (87.3%) persons were examined. The age-sex standardized prevalence of glaucoma was 3.68% (95% CI 3.27 to 4.07). Gender variation of glaucoma was not significant. [OR = 1.13 (CI 95% 0.88 to 1.44)] Glaucoma varied significantly by age groups. (chi2 = 48.2, degree of freedom = 3 P < 0.001) Among those patients diagnosed to suffer from glaucoma, the proportion of open angle, closed angle, secondary glaucoma, ocular hypertension and glaucoma suspects was 13.1%, 21.2%, 21.2%, 14.5% and 30% respectively. Different types of visual disabilities were associated with glaucoma. However, unilateral blindness in glaucoma was unusual. Twenty-five per cent of the glaucoma cases were detected for the first time during the survey. CONCLUSIONS: The prevalence of glaucoma was high and the angle closure type was more compared to the open angle glaucoma.     

青光眼患者局部用药依从性及其影响因素

目的调查青光眼患者局部用药依从性及其影响因素,以期为青光眼患者设计更好的治疗方案。方法调查研究。应用局部药物的青光眼门诊患者120例,采用调查问卷的形式,依照Morisky推荐的评价依从性的标准评定患者的依从性,用单因素logistic回归和两分类变量的关联性检验分析青光眼患者局部用药依从性的影响因素。结果获得有效问卷108份,青光眼患者局部用药依从率为63．9％,不依从率为36．1％;年龄、月收入情况、用药次数、用药方法和医生是否告知对青光眼患者局部用药依从性有影响（X^2=18．752、17．783、13．530、9．022、14．831,P〈0．05）。结论所调查的青光眼患者局部用药的依从性较好：60岁以上、月收入600元以上、每天用药3次、用药方法正确、医生告知的患者,局部用药依从性好：简单、合理的治疗方案以及加强对青光眼患者的宣传教育,可以提高青光眼患者局部用药的依从性。     

Systemic medication usage in glaucoma patients

Objective

To study the prevalence of the systemic use of some common classes of medications by glaucoma patients and their relationship to the prevalence and severity of chronic open-angle glaucoma (COAG) and primary-angle closure glaucoma (PACG).

Trends in the indications for penetrating keratoplasty, 1980-2001

PURPOSE: To study the leading indications and changing trends for penetrating keratoplasty (PK) over the past 3 decades. METHODS: This is a retrospective review of 696 cases of PK. The indications for PKs performed at the Duke University Eye Center during the years 1980-1981, 1990- 1991, and 2000-2001 were tabulated to determine trends over the past 3 decades. The main outcome measures were indications for PK. RESULTS: During this study, 696 PKs were performed. The leading indications for PK and their respective frequencies during 1980-1981, 1990-1991, and 2000-2001 were failed grafts (10.8%, 19.0%, 27.0%, respectively), pseudophakic bullous keratopathy (PBK)/aphakic bullous keratopathy (ABK) (19.4%, 20.6%, 16.7%, respectively), Fuchs dystrophy (15.6%, 13.0%, 23.8%, respectively), keratoconus (13.4%, 8.2%, 11.8%, respectively), and corneal scar (7.0%, 8.9%, 10.7%, respectively). The number of PKs for failed grafts and Fuchs dystrophy increased over time. CONCLUSIONS: In this study, failed graft has gradually become the leading indication for PK, whereas most other studies have reported PBK as the leading indication. Unlike many other studies, Fuchs dystrophy was a common indication for PK.     

Trends in eye injury in the United States, 1992-2001

PURPOSE: To report the trends of eye injury in the United States from 1992 through 2001. METHODS: The National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey were used to collect information on eye injuries from 1992 to 2001. Rates of eye injury per 1000 population were calculated according to age, gender, and race. RESULTS: From 1992 through 2001, the overall estimated rate of eye injury ranged from 8.2 to 13.0 per 1000 population. During this period the incidence of eye injury significantly declined overall, in persons aged 39 years and younger, in both genders, and in the black and white populations (all P <0.05). CONCLUSIONS: From 1992 through 2002, the incidence of eye injury in the United States declined overall, in persons aged 39 and younger, in both genders, and in both racial groups. Certain segments of the population, however, continued to be at high risk (i.e., males and persons aged 39 and younger) of eye injury and represent those groups toward whom prevention resources should be directed.     

Effect of changing medication regimens in glaucoma patients

When glaucoma medication fails to adequately control intraocular pressure (IOP), a second medication is frequently added. Before adding a second drug to patients whose IOP was no longer controlled by 0.5% timolol, we tested the effect of switching to another beta blocker, levobunolol (0.5 or 1%). We also evaluated the effect of study participation on compliance in the control group continuing to receive 0.5% timolol. In each treatment group, the IOP of approximately 30-40% of the patients was successfully controlled for the 3-month study period. The remaining patients did not exhibit significant pressure reductions and were dropped from the study within 2 weeks. We concluded that (1) the results of 'switch' studies without a control group must be interpreted carefully, and (2) the initiation of a 'new regimen' with an equieffective beta blocker may be sufficient to increase compliance and thereby control IOP.