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Policy implications of regional variations in eye disease detection and treatment on Prince Edward Island: a repeated cross-sectional analysis, 2010–2012

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      Abstract

      BackgroundIn Canada, government insurance covers eye care services provided by ophthalmologists and other physicians. However, government coverage for services provided by optometrists, non-medical school trained primary eye care providers, varies regionally. Little is known about the impact of a funding model in which ophthalmologist services are government-insured but services provided by optometrists are not, on eye care utilization and eye disease detection and treatment. We aimed to address this question by examining geographic variations in eye care service utilization on Prince Edward Island (PEI).MethodsPEI physician-billing data from 2010 to 2012 was analyzed across five distinct geographic regions (Charlottetown, Summerside, Prince, Queens & Kings and Stratford). The residential location of patients and practice locations of eye care providers were identified using the first three digits of their respective postal code. Age-standardized rates were computed for comparisons across different regions.ResultsThere were six ophthalmologists practicing on PEI, five with offices in Charlottetown. Twenty optometrists practiced on the island with offices across the province. Stratford is closest and Prince farthest from Charlottetown. Age-standardized utilization rates of ophthalmologists per 100 populations were 10.44 in Charlottetown and 10.90 in Stratford, which was significantly higher than in other regions (7.74–8.92; p < 0.05). The disparities were most pronounced amongst the elderly. The prevalence of glaucoma visits was higher in Charlottetown (6.10%) and Stratford (6.38%) and lower in other regions. A similar pattern was observed for the prevalence of cataract visits. While the prevalence of diabetes visits was higher in Prince and Summerside, the utilization of ophthalmologists by people with diabetes was almost twice as high in Charlottetown (6.49%) than in Prince (3.88%).ConclusionsThe observed discrepancies in vision care utilization across geographic regions were likely attributed to barriers in accessing government-insured, geographically concentrated ophthalmologists, as opposed to a reflection of the true differences in eye disease occurrence. The lower prevalence of glaucoma visits in regions farther away from ophthalmologist offices may result in delayed detection and blindness in this population. Encouraging ophthalmologists to work in other areas of the province and/or to publicly fund services provided by optometrists may mitigate the observed disparities.Trial registrationNot applicable.

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      Prevalence of open-angle glaucoma among adults in the United States.

      To estimate the prevalence and distribution of open-angle glaucoma (OAG) in the United States by age, race/ethnicity, and gender. Summary prevalence estimates of OAG were prepared separately for black, Hispanic, and white subjects in 5-year age intervals starting at 40 years. The estimated rates were based on a meta-analysis of recent population-based studies in the United States, Australia, and Europe. These rates were applied to 2000 US census data and to projected US population figures for 2020 to estimate the number of the US population with OAG. The overall prevalence of OAG in the US population 40 years and older is estimated to be 1.86% (95% confidence interval, 1.75%-1.96%), with 1.57 million white and 398 000 black persons affected. After applying race-, age-, and gender-specific rates to the US population as determined in the 2000 US census, we estimated that OAG affects 2.22 million US citizens. Owing to the rapidly aging population, the number with OAG will increase by 50% to 3.36 million in 2020. Black subjects had almost 3 times the age-adjusted prevalence of glaucoma than white subjects. Open-angle glaucoma affects more than 2 million individuals in the United States. Owing to the rapid aging of the US population, this number will increase to more than 3 million by 2020.
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        Prevalence of glaucoma. The Beaver Dam Eye Study.

        The purpose of this study is to determine the prevalence of glaucoma in the population participating in the Beaver Dam Eye Study (n = 4926). All subjects were examined according to standard protocols, which included applanation tonometry, examination of the anterior chamber, perimetry, grading of fundus photographs of the optic disc, and a medical history interview. Visual field, cup-to-disc ratio, and intraocular pressure (IOP) criteria were used to define the presence of open-angle glaucoma. Definite open-angle glaucoma was defined by the presence of any two or all three of the following: abnormal visual field, large or asymmetric cup-to-disc ratio, high IOP. The overall prevalence of definite open-angle glaucoma was 2.1%. The prevalence increased with age from 0.9% in people 43 to 54 years of age to 4.7% in people 75 years of age or older. There was no significant effect of sex after adjusting for age. Of the 104 cases of definite open-angle glaucoma, 33 had IOPs less than 22 mmHg in the involved eye. Hemorrhage on the optic disc was found in 46 people; 2 of these had glaucoma. Narrow-angle glaucoma was rare, with two definite cases in the population. The prevalence of open-angle glaucoma in Beaver Dam is similar to that in other white populations. Findings from this study re-emphasize the notion that estimates of glaucoma prevalence should be based on assessing multiple risk indicators.
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          Prevalence of age-related lens opacities in a population. The Beaver Dam Eye Study.

          Age-related lens opacities are common and are a frequent cause of loss of vision. The Beaver Dam Eye Study was designed to estimate the prevalence and severity of lens opacities in a rural community in the United States. Adults between the ages of 43 and 84 years, identified by private census, were examined and participated in the study (n = 4926). Photographs were taken of the lenses and were graded in masked fashion according to a standardized protocol. For nuclear sclerosis, more severe levels occurred more commonly in older age groups and in women. Overall, 17.3% had nuclear sclerosis more severe than level 3 in a 5-step scale of severity. Cortical opacities increased with increasing age and were more common in women. They were found in 16.3% of the population. Posterior subcapsular opacities occur in 6.0% of the population. There was a significant trend of greater prevalence at older ages, but no sex effect. The frequency of early cataract increased in both sexes through the age group 65 to 74 years, but declined in those 75 years of age and older. The frequency of late cataract increased consistently with age. Women were more severely affected than men. This study confirms that lens opacities are common in adults in the United States. These data are important for providing for social and health care needs. It is important to determine causes of cataracts in order to develop preventive programs.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Dalla Lana School of Public Health, , University of Toronto, ; 155 College St, Toronto, ON M5T 3M7 Canada
            [2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Ophthalmology and Vision Sciences, , University of Toronto, ; 340 College Street, Suite 400, Toronto, ON M5T 3A9 Canada
            [3 ]ISNI 0000 0004 4675 7586, GRID grid.470439.d, Health PEI, ; 16 Garfield Street, Charlottetown, PEI C1A 7N8 Canada
            [4 ]ISNI 0000 0000 8644 1405, GRID grid.46078.3d, University of Waterloo, ; 200 University Ave W, Waterloo, ON N2L 3G1 Canada
            Contributors
            ORCID: http://orcid.org/0000-0003-0617-9243, anamm.khan@mail.utoronto.ca
            graham.trope@uhn.ca
            drrichardwedge@gmail.com
            y.buys@utoronto.ca
            seldefrawy@KensingtonHealth.org
            qsc@live.ca
            yaping.jin@utoronto.ca
            Journal
            BMC Health Serv Res
            BMC Health Serv Res
            BMC Health Services Research
            BioMed Central (London )
            1472-6963
            10 April 2018
            10 April 2018
            2018
            : 18
            29636054
            5894155
            3068
            10.1186/s12913-018-3068-z
            © The Author(s). 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: Canadian Institutes for Health Research
            Award ID: HRA 126901
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2018

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