Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: A US multisite retrospective study

David K. Gieser, R. Tracy Williams, William O'Connell, Louis R. Pasquale, Bruce P. Rosenthal, John G. Walt, Laura M. Katz, Lisa R. Siegartel, Lujing Wang, Lisa C. Rosenblatt, Lee S. Stern, John J. Doyle

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


PURPOSE: Glaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC). MATERIALS AND METHODS: A chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling. RESULTS: Mean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [$2170 (SD=$2252) vs. $1202 (SD=$1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%. CONCLUSIONS: End-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease.

Original languageEnglish
Pages (from-to)419-425
Number of pages7
JournalJournal of Glaucoma
Issue number5
StatePublished - Oct 2006
Externally publishedYes


  • Blindness
  • Direct costs
  • End-stage primary open-angle glaucoma
  • Resource use
  • Visual rehabilitation care


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