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Changes in glaucoma management following visual field testing and optical coherence tomography
  1. Michelle T. Sun,
  2. Kuldev Singh,
  3. Sophia Y. Wang
  1. Department of Ophthalmology, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Sophia Y. Wang, Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA; sywang{at}


Background Optimal utilisation of investigations in glaucoma management remains unclear. We aimed to assess whether a temporal association exists between such testing and management changes.

Methods Retrospective observational study using nationwide healthcare insurance claims database. Glaucoma outpatient encounters from patients aged ≥40 years with/without Humphrey visual field (HVF) and/or optical coherence tomography (OCT) were identified. An encounter was considered associated with an intervention if surgery occurred within 90 days, or if medication change or laser trabeculoplasty (LT) occurred within 30 days.

Results 12 669 324 outpatient encounters of 1 863 748 individuals from 2003 to 2020 were included. HVF and OCT was performed during 32.8% and 22.2% of encounters respectively. Of the 36 763 (0.3%) encounters preceding surgery, 28.1% included HVF, 11.9% had OCT and 8.5% both. 79 181 (0.6%) visits preceded LT, of which 28.2% had HVF, 13.2% OCT and 9.3% both. Of the 515 899 (4.5%) encounters preceding medication changes, 29.1% had HVF, 16.7% OCT and 12.2% both. Compared with encounters with no investigations, those with HVF and/or OCT were associated with a 49% increased odds of a management change (p<0.001). In multivariate analyses, compared with encounters without investigations, visits with HVF alone had higher odds of subsequent surgery and LT, while HVF and/or OCT were associated with higher odds of medication change (p<0.001 for all).

Conclusion Glaucoma therapeutic changes occurred following approximately 5% of outpatient encounters. Surgery and LT were more likely to occur following a visit with a HVF rather than an OCT, while either investigation was associated with a higher odds of medication change.

  • glaucoma

Data availability statement

Data may be obtained from a third party and are not publicly available. Clinformatics Data Mart (OptumInsight)

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Data availability statement

Data may be obtained from a third party and are not publicly available. Clinformatics Data Mart (OptumInsight)

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  • Twitter @MichelleTianSun, @eyelovedata

  • Contributors Conception and design of the study: KS, SW and MTS. Data acquisition, analysis and interpretation of data for the work: MTS and SW. Drafting the work and revising it critically for important intellectual content: MTS, KS and SW. All authors approved the version to be published and agree to be accountable for all aspects of the work. Guarantor of work: SYW

  • Funding Funding/support: Departmental support from Research to Prevent Blindness and National Eye Institute P30-026877 (SW); National Library of Medicine T15 LM 007033 (SW). Financial Disclosures: KS is a consultant for: Alcon, Allergan, Glaukos, Ivantis, Santen and Sight Sciences.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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