Researchers developing new understanding of glaucoma.

In the New York Times (7/15) Times Essentials: Reporter’s File, Peter Jaret observed that “a new paradigm for understanding glaucoma has emerged. Glaucoma isn’t simply an eye disease, experts now say, but rather a degenerative nerve disorder, not unlike Alzheimer’s or Parkinson’s disease.” While “researchers still recognize high pressure within the eye as a leading risk factor for glaucoma,” it is becoming clear that the condition “begins with injury to the optic nerve as it exits the back of the eye. The damage then spreads, moving from one nerve cell to adjoining nerve cells.” Neeru Gupta, MD, PhD, of the University of Toronto, explained, “In glaucoma, we’ve shown that when your retinal ganglion cells are sick, the long axons that project from the eye into the brain are also affected, resulting in changes that we can detect in the vision center of the brain.” This “phenomenon, called transynaptic damage, occurs in Alzheimer’s and Parkinson’s disease, as well.”

Glaucoma surgeries increasing while Medicare reimbursement decreases, study suggests. MedPage Today (7/15, Fiore) reported that, according to a study published in the July issue of the Archives of Ophthalmology, “the number of glaucoma surgeries is on the rise, but Medicare reimbursement for the procedures has been decreasing.” For the study, researchers from Exponent, Alcon Research, and the Bloomberg School of Public Health analyzed “Part B Medicare data for 100,000 beneficiaries from 1997 to 2006.” The team “found that from 1997 to 2001, there was an overall decrease in both the number of procedures and the amount of annual payments, but there was an increase in the number of procedures in the following years, reaching a total of 414,980 in 2006.” The investigators attributed the increase to “advancements in technology and a change in calculating the global period for reimbursement purposes.” The authors also “noted that payments for trabeculectomies decreased over time, while annual payments for newer procedures, such as cyclophotocoagulation and shunt-related procedures, have increased.”

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