Concluding that glaucoma care is cost effective and benefits patient quality of life, and definitively proving it, are 2 different things. To begin with, there is the primary paradox of glaucoma treatment—on the first day of treatment, quality of life inevitably takes a hit and costs begin, but the benefits can’t be seen for months or years. Fortunately, new information is available that clearly demonstrates the hidden costs of progressive glaucoma and shows us how preventing glaucoma progression could likely reduce these costs.
Felipe Medeiros, MD, PhD, has looked at the association between rates of visual field progression and depressive symptoms in patients with glaucoma. He found that as binocular automated perimetric sensitivity decreased, geriatric depression scale scores similarly decreased. Even more impressively, this relationship held in a multivariable model adjusting for a number of potential confounders, such as visual acuity, age, and baseline disease severity.
In a similar line of research, Medeiros and colleagues investigated the relationship between visual field progression and risk of falling in glaucoma patients. Roughly a quarter of glaucoma patients had fallen in the past year and those who had fallen had twice the prevalence of binocular visual field loss. Again, this relationship remained after adjusting for potential confounding variables such as age and disease severity.
To pull all of this together, Dana Blumberg, MD, MPH, and researchers at Columbia University looked at health resource utilization and glaucoma in Medicare beneficiaries. The primary finding of this longitudinal observational study in more than 70 000 Medicare beneficiaries was that patients with glaucoma have a greater use of inpatient and home health aide services and have total higher annual nonoutpatient medical costs than those without glaucoma. Perhaps these costs are tied to conditions such as depression and falling, as demonstrated by Dr Medeiros. In any case, it is important to realize that glaucoma is associated with other serious conditions—conditions that utilize a good deal of Medicare costs. Treating glaucoma, and perhaps breaking the cycle of these costs, may lead to significant financial and quality-of-life benefits for patients with glaucoma and could decrease the costs of associated conditions.