Analysis of Angle Closure Glaucoma Identifies Most Expensive Scenarios

While there were many risk factors, types of Medicare insurance product remained a significant predictor of being in the costliest 5% group, which could indicate easier access to PACG-related procedures like LPI compared to patients with commercial HMOs. Photo: Nathan Lighthizer, OD. Click image to enlarge. The prevalence of primary angle-closure glaucoma (PACG) is rising and contributes to the increasing costs of glaucoma care, which was previously reported at over $3 billion annually in the United States. In a recent study, researchers analyzed the two-year eye care costs associated with newly diagnosed PACG in the United States between 2009 and 2017. The findings were reported in the Journal of Glaucoma.A total of 12,673 patients with a diagnosis of PACG during the study period were identified based on ICD codes. Logistic regression modeling was performed to identify risk factors for being in the top 5% of cumulative two-year costs.Newly diagnosed patients incurred on average $2,960 in eye care costs in the first two years following PACG diagnosis. Procedure costs were the highest in the first six months (56.7%), followed by office visits (20%), prescription medications (15%) and diagnostic tests (8.2%); 53% of newly diagnosed PACG patients had some kind of procedure-related spending in the first two years.“Overall, these cost-related findings suggest that treatments with laser and surgery play a more central role in PACG than POAG, and that medications play a smaller long-term role in PACG, perhaps due to effective IOP lowering produced by these treatment procedures,” the authors wrote in their paper.Patients who had a recent or established diagnosis of anatomical narrow angles prior to PACG diagnosis incurred significantly higher costs than those without, the study found.“Although we were unable to observe measures of ocular health, such as intraocular pressure (IOP), that could explain these differences, we speculate that the higher pre-diagnosis cost reflects diagnostic testing to confirm diagnosis of PACG or treatments administered to prevent conversion” to PACG, the authors explained in their article. Black patients had 1.53 times higher odds of being in the most expensive group compared to non-Hispanic white patients. The authors speculate that patients incurring higher costs have greater disease severity, such as higher IOP or worse vision at initial diagnosis. Because older age is a risk factor for both cataracts and PACG; the authors explained that it is intuitive that older patients with PACG are more likely to have visually significant cataracts and receive lens extraction as a primary treatment. “Although we accounted for age in our multivariable analysis, types of Medicare insurance product remained a significant predictor of being in the costliest 5% group, which could indicate easier access to PACG-related procedures compared to patients with commercial HMOs,” the authors explained in their paper.It's worth noting that these findings reveal aspects of current practice patterns that may have implications for recommendations regarding PACG management. In the two years after the initial PACG diagnosis, laser peripheral iridotomy (LPI) was the most common procedure (37.4%) followed by lens extraction (22.9%). However, among patients who underwent lens extraction at any time in the sample or lookback period, 41.1% received at least one LPI within the preceding two years.“Although LPI effectively widens the angle in most eyes with narrow angles, the EAGLE Trial reported a cost-saving benefit associated with earlier lens extraction compared to LPI,” the authors explained. “This approach is supported by our finding that overall eye care costs were higher among those who received LPI anytime in our sample period versus those who did not ($3,729.28 vs. $2,415.67).”“Together, recent findings on racial disparities in the detection, treatment and cost of PACG in the US support the need for additional research to identify the underlying cause of these disparities and develop novel objective methods to risk-stratify patients for PACG,” the authors concluded in their article.Click here for the journal source. Guth D, Apolo G, Seabury SA, et al. Longitudinal trends in resource utilization associated with newly diagnosed primary angle closure glaucoma in the United States. J Glaucoma. July 18, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.