OBJECTIVES: Glaucoma is an optic neuropathy characterized by irreversible visual impairment, with a 2%-7% prevalence in US adults over 65. Primary glaucomas (PGs), the most common types of glaucoma, are caused by increased intraocular pressure. Trabeculectomy is a common surgery to relieve intraocular pressure. The objective of this study is to characterize US Medicare patients with PGs and assess possible regional variations in trabeculectomy use in the context of the 2020 COVID-19 pandemic.

METHODS: A retrospective analysis was conducted using Medicare LDS inpatient, outpatient, and carrier claims from 2017-2021. Analysis-eligible patients were ≥65 years in 2017, alive with continuous Part A/B coverage throughout the study period, and included in the 5% random carrier data sample. Patients were identified via ICD-10-CM codes for PGs (H40.11/H40.12/H40.2) and categorized by region.

RESULTS: Of analysis-eligible patients, 6% (n=93,254) were PG diagnosed within the 5-year period, with a median age of 79 years in 2021. 59% were female. 78%, 13%, and 9% were White, Black, and other race/ethnicity. 40%, 21%, 19%, 19%, and <1% were in the South (S), Midwest (MW), Northeast (NE), West (W), and Other. The number of patients with annual medically attended PG decreased from 68,778 in 2019 to 63,319 in 2020 and rebounded to 65,275 in 2021, with a modest decline in rate of trabeculectomy from 5.3% in 2019 to 4.8% in 2020, and rebound to 5.0% in 2021. The rate of decline in trabeculectomy use from 2019 to 2020 was below the national average of -9% in the MW (-15%) and NE (-12%).

CONCLUSIONS: This analysis of US Medicare Part A/B claims revealed a concurrent decline in 2020 of medically attended PG and trabeculectomy rates, both rebounding in 2021. Additional research is warranted to further investigate drivers of trabeculectomy decline, including alternative procedures for PG and impact on outcomes.