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. 2022 Apr 1;140(4):345-353.
doi: 10.1001/jamaophthalmol.2022.0052.

Trends in Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Medicare Part B Fee-for-Service Beneficiaries

Elizabeth A Lundeen  1 , Linda J Andes  1 , David B Rein  2 , John S Wittenborn  2 , Erkan Erdem  3 , Qian Gu  3 , Jinan Saaddine  1 , Giuseppina Imperatore  1 , Emily Y Chew  4
Affiliations

Trends in Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Medicare Part B Fee-for-Service Beneficiaries

Elizabeth A Lundeen et al. JAMA Ophthalmol. .

Abstract

Importance: While diabetes prevalence among US adults has increased in recent decades, few studies document trends in diabetes-related eye disease.

Objective: To examine 10-year trends (2009-2018) in annual prevalence of Medicare beneficiaries with diabetes with a diagnosis of diabetic macular edema (DME) or vision-threatening diabetic retinopathy (VTDR) and trends in treatment.

Design, setting, and participants: In this cross-sectional study using Centers for Medicare & Medicaid Services research identifiable files, data for patients 65 years and older were analyzed from claims. Beneficiaries were continuously enrolled in Medicare Part B fee-for-service (FFS) insurance for the calendar year and had a diagnosis of diabetes on 1 or more inpatient claims or 2 or more outpatient claims during the calendar year or a 1-year look-back period.

Main outcomes and measures: Using diagnosis and procedure codes, annual prevalence was determined for beneficiaries with 1 or more claims for (1) any DME, (2) either DME or VTDR, and (3) anti-vascular endothelial growth factor (VEGF) injections, laser photocoagulation, or vitrectomy, stratified by any DME, VTDR with DME, and VTDR without DME. Racial and ethnic disparities in diagnosis and treatment are presented for 2018.

Results: In 2018, 6 960 823 beneficiaries (27.4%) had diabetes; half were aged 65 to 74 years (49.7%), half (52.7%) were women, and 75.7% were non-Hispanic White. From 2009 to 2018, there was an increase in the annual prevalence of beneficiaries with diabetes who had 1 or more claims for any DME (1.0% to 3.3%) and DME/VTDR (2.8% to 4.3%). Annual prevalence of anti-VEGF increased, particularly among patients with any DME (15.7% to 35.2%) or VTDR with DME (20.2% to 47.6%). Annual prevalence of laser photocoagulation decreased among those with any DME (45.5% to 12.5%), VTDR with DME (54.0% to 20.3%), and VTDR without DME (22.5% to 5.8%). Among all 3 groups, prevalence of vitrectomy in 2018 was less than half that in 2009. Prevalence of any DME and DME/VTDR was highest among Hispanic beneficiaries (5.0% and 7.0%, respectively) and Black beneficiaries (4.5% and 6.2%, respectively) and lowest among non-Hispanic White beneficiaries (3.0% and 3.8%, respectively). Among those with DME/VTDR, anti-VEGF was most prevalent among non-Hispanic White beneficiaries (30.3%).

Conclusions and relevance: From 2009 to 2018, prevalence of DME or VTDR increased among Medicare Part B FFS beneficiaries alongside an increase in anti-VEGF treatment and a decline in laser photocoagulation and vitrectomy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rein reported grants from US Centers for Disease Control and Prevention (CDC) Vision Health Initiative during the conduct of the study. Mr Wittenborn reported grants from the CDC Vision Health Initiative during the conduct of the study. Dr Erdem reported grants from Health and Human Services and funding from NORC as a subcontract from a CDC cooperative agreement during the conduct of the study. Dr Gu reported funding from NORC as a subcontract from a US Centers for Disease Control and Prevention cooperative agreement during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Annual Crude National Prevalence of Medicare Beneficiaries With Diabetes With 1 or More Claims for Diabetes-Related Eye Diseases (2009-2018)
A, Diabetic macular edema (DME)/vision-threatening diabetic retinopathy (VTDR) was defined as diabetic macular edema, severe nonproliferative diabetic retinopathy (with or without diabetic macular edema), or proliferative diabetic retinopathy (with or without diabetic macular edema). B, Any DME was presented as a trend line (separate from DME/VTDR in A) and was characterized as any diagnosis of DME, by itself or with any stage of diabetic retinopathy. C, Non–vision-threatening diabetes-related eye disease was characterized as background diabetic retinopathy, nonproliferative diabetic retinopathy (not otherwise specified), unspecified diabetic retinopathy without macular edema, mild nonproliferative diabetic retinopathy (without DME), moderate nonproliferative diabetic retinopathy (without DME), diabetes with ophthalmic manifestations, or other diabetic ophthalmic complication.
Figure 2.
Figure 2.. Annual Crude National Prevalence of Medicare Beneficiaries With Diabetes and 1 or More Claims for Treatment (2009-2018)
Vision-threatening diabetic retinopathy (VTDR) was defined as severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy. DME indicates diabetic macular edema; VEGF, vascular endothelial growth factor.
Figure 3.
Figure 3.. Racial and Ethnic Differences in the 2018 Crude National Prevalence of Medicare Beneficiaries With Diabetes With 1 or More Claims for Diabetic Macular Edema or Vision-Threatening Diabetic Retinopathy (DME/VTDR) or Any DME
DME/VTDR was defined as DME, severe nonproliferative diabetic retinopathy (with or without DME), or proliferative diabetic retinopathy (with or without DME). Presented separately is the prevalence of any DME, characterized as any diagnosis of DME by itself or with any stage of diabetic retinopathy.
Figure 4.
Figure 4.. Medicare Beneficiaries With Diabetes, Stratified by Racial and Ethnic Group, Who Had 1 or More Claims for Treatment of Diabetes-Related Eye Diseases in 2018, Among Those With Diabetic Macular Edema or Vision-Threatening Diabetic Retinopathy (DME/VTDR)
DME/VTDR was defined as DME, severe nonproliferative diabetic retinopathy (with or without DME), or proliferative diabetic retinopathy (with or without DME). VEGF indicates vascular endothelial growth factor.
See this image and copyright information in PMC

References

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