If you perform or advocate for ODs to perform laser trabeculoplasty (LTP), you should know about this study.

A recent study shows optometrists performing LTP have a “189% greater hazard as compared to ophthalmologists”.
After reviewing Medicare claims from glaucoma patients in Oklahoma from 2008-2013, over 1000 eyes that underwent LTP were included in the study.  Using ICD-9 and CPT codes, they tracked the number of LTPs completed, on which eye and whether it was done by an optometrist or ophthalmologist.
They found “patients who underwent LTP by an optometrist had an approximate 2-fold higher likelihood of undergoing additional LTPs in the same eye compared with others who received this procedure by an ophthalmologist”.

Some potential reasons for the difference in outcomes include:
-differences in disease severity between the 2 groups
-differences in selection of patients who are appropriate candidates for LTP between the 2 types of eye care professionals
-differences in how the LTP was performed, including the type of laser used, laser settings, amount of the drainage angle treated in one setting
-the fact that ophthalmologists can perform incisional surgery on patients with failed LTP, whereas optometrists may perform additional LTPs
-Some of the patients undergoing LTP by optometrists may reside in communities where access to incisional glaucoma surgery is limited

The authors state it’s difficult to discern the reasons for the differences observed with only claims data.  However, they “urge state legislatures and health policy makers to be cautious about giving optometrists privileges to perform LTP in other states until additional research is performed”.

Jaclyn Garlich
Dr. Garlich graduated from the New England College of Optometry in 2010 and completed a residency in primary care and ocular disease at the St. Louis VA. In 2013, she developed an optometry clinical reference mobile app available in the iTunes store. In 2016, she founded 20/20 Glance, a weekly optometry newsletter that gives a rundown on clinically relevant optometry news in an easy to digest format.

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