Changes in Australian practice patterns for glaucoma management

Abstract

Purpose: To characterise trends in Australian glaucoma management between 2003 and 2017, considering developments in glaucoma diagnostics, pharmaceutical, and surgical care during this period.

Method: Retrospective audit of the number and cost of Medicare Benefits Schedule item number reimbursements and dispensed Pharmaceutical Benefits Scheme prescriptions.

Results: The number of medication prescriptions increased by 18.1%, with prostaglandin analogues comprising 66.5%. The use of beta‐blockers declined 72.9%. An 9.2‐fold increase in fixed‐combination medications and 281‐fold increase in unpreserved medication prescriptions was observed, currently accounting for 35.7% and 6.5% of all prescriptions respectively. In 2017, optometrists generated 1.87% of glaucoma prescriptions. Reimbursements for computerised perimetry increased 3,342% for optometrists and 58% for ophthalmologists. There were significant increases in laser procedure rates including laser trabeculoplasty 4.61‐fold, laser iridotomy 2.55‐fold, and cyclodestructive procedures 2.33‐fold. Micro‐invasive glaucoma surgery (MIGS) increased 715% from 2014. Adjusted for Medicare population, MIGS are performed at more than twice the rate of primary filtering operations. The number of primary filtering operations increased 29% over the study period, however there was a 3.83‐fold increase in glaucoma drainage device insertions.

Conclusions: There is a significant increase in MIGS procedure rates and corresponding costs since 2014. Glaucoma drainage device implantation, cyclodestructive procedures, laser trabeculoplasty, and laser iridotomy rates have also increased over the study period. Whereas the increase in rate of primary filtering operations is in proportion to the ageing population. Prostaglandin analogues remain the primary medication class prescribed with significantly increasing use of fixed‐combination and unpreserved medications.