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Paul P. Lee, MD, JD; Zachary W. Feldman, BA; Jan Ostermann, PhD; Derek S. Brown, MA; Frank A. Sloan, PhD

Arch Ophthalmol. 2003;121:1303-1310.

Objective  To describe the prevalence across time of 3 chronic eye diseases among a representative cohort of elderly subjects.

Study Design  Longitudinal observation of Medicare claims.

Population  A random sample of Medicare beneficiaries 65 years and older, nationally representative at baseline.

Main Outcome Measures  Diagnosis of diabetic retinopathy, glaucoma, and age-related macular degeneration.

Methods  Beneficiaries were followed from 1991 to 1999 unless mortality or enrollment in a health maintenance organization for 6 or more months in a year intervened. Claims data were analyzed for the presence of codes from the International Classification of Diseases, Ninth Revision, Clinical Modification, indicating 1 of the 3 conditions. Transitions between severity stages were also evaluated.

Results  Of 20 325 beneficiaries in 1991, 10 476 were available for analysis in 1999. The prevalence of diabetes mellitus increased from 14.5% in 1991 to 25.6% by 1999, with diabetic retinopathy among persons with diabetes mellitus increasing from 6.9% to 17.4%. Primary open-angle glaucoma increased from 4.6% to 13.8%. The percentage of glaucoma suspects increased from 1.5% to 6.5%, as did the percentage of narrow-angle glaucoma (0.7%-2.7%). The prevalence of age-related macular degeneration increased from 5.0% to 27.1%. Overall, the proportion of subjects with at least 1 of these 3 diseases increased from 13.4% to 45.4%.

Conclusions  The clinical diagnosis of major chronic eye diseases associated with aging increased dramatically in a longitudinal sample. At the end of 9 years, nearly half of the surviving Medicare beneficiaries had at least 1 of these diseases.

From the Department of Ophthalmology, School of Medicine (Dr Lee), Department of Economics (Dr Sloan and Messrs Feldman and Brown), and Center for Health Policy, Law, and Management (Drs Ostermann and Sloan), Duke University, Durham, NC. The authors have no relevant financial interest in this article.

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