CORRELATION OF RETINAL IMAGING UTILIZATION WITH ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AND PANRETINAL PHOTOCOAGULATION USAGE FROM 2013 TO 2021.

Abstract

To analyze trends in retinal imaging utilization and assess whether there is a correlation with anti-vascular endothelial growth factor (anti-VEGF) and panretinal photocoagulation (PRP) usage. We performed a cross-sectional study using the publicly available Medicare Physician & Other Practitioners-by Provider and Service database. Data were identified using procedural codes for ocular coherence tomography, fundus photography, fluorescein angiography (FA), indocyanine-green angiography, ophthalmic ultrasound, intravitreal anti-VEGF agents, and PRP from 2013 to 2021. Time-based analyses were also conducted for the individual periods 2013 to 2016 and 2017 to 2021 to account for changes in the billing of FA from unilateral to unilateral or bilateral after 2016. Although ocular coherence tomography increased in relative utilization ( P < 0.001 across 2013-2021, 2013-2016, and 2017-2021), there was a decline in relative utilization for FA, FA + indocyanine-green angiography, ultrasound, and fundus photography ( P < 0.001 for all modalities across 2013-2021, 2013-2016, and 2017-2021). For PRP, positive associations in annual volume were observed with FA ( P < 0.001, R 2 = 0.81) and FA + indocyanine-green angiography ( P < 0.001, R 2 = 0.87), whereas a negative association in annual volume was observed with ocular coherence tomography ( P = 0.028, R 2 = 0.52). For anti-VEGF injections, a positive association in annual volume was observed with ocular coherence tomography ( P < 0.001, R 2 = 0.84), whereas negative associations were observed with FA ( P < 0.001, R 2 = 0.89) and FA + indocyanine-green angiography ( P < 0.001, R 2 = 0.90). Although anti-VEGF use returned to 2019 levels by 2021, PRP use declined by 30% during the same period. Ocular coherence tomography continues to rise as a percentage of all retinal imaging ordered, whereas FA has declined. This trend corresponds to an increase in anti-VEGF injections and a decline in PRP in the treatment of retinal diseases.