Purpose: To identify the cost to the Medicare program for patients with either stable or progressive vision loss and to estimate the impact on eye-related and non-eye related care. Design: Retrospective cohort study. Participants: The study population was Medicare beneficiaries included in the standard 5% analytic sample and continuously enrolled from 1999 to 2003, excluding Medicare managed-care enrollees. Methods: Vision loss was categorized as moderate loss, severe loss, and blindness, based on International Classification of Diseases 9, Clinical Modification codes. Main Outcome Measures: Average yearly cost of eye-related and non-eye related medical care during 1999 to 2003, in 2003 dollars. Secondary outcomes: (1) depression, (2) injury, (3) skilled nursing facility (SNF) utilization, and (4) long-term care facility (LTC) admission. Results: Compared with patients with normal vision, excess adjusted mean eye-related costs were $345, $407, and $237 annually for those with moderate loss, severe loss, and blindness, respectively; annual excess non-eye related costs were $2193, $3301, and $4443, respectively. At each level of vision loss, those progressing from a presumably normal state at baseline incurred higher Medicare costs than those with that level of vision loss at baseline. Any degree of progressive vision loss was associated with an increased risk of depression, injury, SNF utilization, and LTC admission. Identifiable costs attributable to these complications explained 27% to 41% of the excess costs associated with vision loss. Conclusions: Medicare beneficiaries with coded diagnoses of vision loss incur significantly higher costs than those with normal vision, and approximately 90% of these costs are non-eye related medical costs. Extrapolating to the entire Medicare population, blindness and vision loss are associated with $2.14 billion in 2003 non-eye related medical costs. Preventing vision loss is not only a medical imperative but also an economic one.
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