Strabismus surgery among medicare beneficiaries

Purpose. The type, number and indications for the performance of strabismus surgery among older patients in the United States are unknown. Such data are needed to better understand this facet of ophthalmological care of senior citizens. Methods. The Medicare Part B claims experience for 1995 was reviewed for the frequency at which each of the defined strabismus surgical procedures in CPT° were performed throughout the United States. To determine the indications for the surgical procedures that were performed, a 5% sample of claims was reviewed for the pertinent ICD9-CM diagnostic codes. Results. There were 5,732 surgical procedures and 277 Botox® injections performed during 1995. Two-thirds of the surgical procedures were coded as horizontal surgery and one-third as vertical surgery. Adjustable sutures were used in 1240 cases (22%). The code for reoperation surgery or surgery with restriction of the extraocular muscles was used in 930 cases (16%). Surgery on the superior oblique was reported for only 162 cases. Surgery for a slipped muscle was reported 57 times. The most common diagnosis for horizontal surgery was exotropia. Paralytic and thyroid strabismus were each more frequently noted with vertical strabismus surgery. Conclusions. These data confirm a low frequency of strabismus surgical procedures and injections among Medicare beneficiaries. Overwhelmingly the strabismus surgery is horizontal and most often for exotropia. These procedures are initial operations in most cases. Despite the fairly widespread acceptance of adjustable sutures for adult patients in the United States, they are not utilized frequently for the treatment of older patients. These data suggest an unmet need for strabismus services in this age group, which would be expected to grow as the population continues to age.