Use of retinal procedures in medicare beneficiaries from 1997 to 2007

Objective: To observe how the treatment of retinal conditions changed over the preceding decade. Methods: Medicare fee-for-service data claims filed between 1997 and 2007 were analyzed. Results: Fewer than 5000 intravitreal injections of a pharmacological agent were performed annually between 1997 and 2001. Thereafter, the annual number of intravitreal injections more than doubled every year through 2006, reaching a high of 812 413 in 2007. Photodynamic therapy procedures decreased 83% from a peak of 133 565 procedures in 2004 to 22 675 procedures in 2007, while laser treatment of choroidal lesions or neovascularization decreased 83% from a peak of 82 089 in 1999 to a minimum of 13 821 in 2007. Vitrectomies for primary retinal detachment (with or without scleral buckling) increased 72% over the study period from 11 212 in 1997 to 19 923 in 2007, while scleral buckles performed without vitrectomy decreased 69% from 8691 to 2660. Substantial volume increases were also observed for vitrectomy with retinal membrane stripping (90% increase from 29 426 in 1997 to 56 051 in 2007) or endolaser panretinal photocoagulation (86% increase from 10 319 in 1997 to 19 154 in 2007). Volumes of pneumatic retinopexy, laser prophylaxis for retinal detachment, laser treatment for retinal edema, and laser treatment for retinopathy all changed less than 25% from 1997 and 2007. Conclusions: Marked changes in the use of several retinal procedures occurred between 1997 and 2007, particularly in the treatment of macular degeneration and retinal detachment. These changes point to greater acceptance and incorporation of vitrectomy and intravitreal injection as treatment modalities.