of work This 3-year study has 3 specific aims: (1) Examine patterns of longitudinal use of eye care diagnostic and therapeutic services for major eye diseases;(2) Assess whether visual loss has been reduced by new innovations in ocular therapy for age-related macular degeneration (AMD) and greater intensity of therapy in diabetic eye diseases (both systemic and ocular);and (3) Assess utilization, conformance with guidelines, and cardiovascular, cerebrovascular, and nephropathy outcomes.
Aim 1 investigates hyperbolic discounting as an explanation of nonuse and diffusion of new therapies for treatment of AMD.
Aim 2 performs comparative effectiveness analysis of effects of AMD therapies and diabetic eye therapies on visual and other complications.
Aim 3 investigates effects of diagnostic and therapeutic procedures, including prescribed drugs, on cardiovascular, cerebrovascular, and nephropathy outcomes using instrumental variable (IV) and control function methods. To complement the IV analysis, this study investigates the process of selection into care, assessing roles of such observables as clinical, demographic and financial factors on selection. National, longitudinal data bases to be used include: Medicare 5% claims data merged with vital statistics information from 1991-2010;Health and Retirement Survey data on Medicare beneficiaries merged with Medicare claims for 1993-2008;and Medicare Current Beneficiary Survey data also merged with administrative information from Medicare, 1991-2009.

Public Health Relevance

This study provides important information about reasons individuals use Medicare-covered services. New and promising treatments in age-related macular degeneration have been developed but their effects on long-run visual outcomes and associated complications in a national setting remain to be demonstrated. Our study will provide recent national evidence on these issues. We will document whether appropriate use of recommended care and therapeutic procedures leads to better health outcomes among persons with (1) major eye diseases and (2) diagnosed with diabetes mellitus.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Baker, Colin S
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Duke University
Schools of Arts and Sciences
United States
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Sloan, Frank A; Hanrahan, Brian W (2014) The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration. JAMA Ophthalmol 132:456-63
Stein, Joshua D; Hanrahan, Brian W; Comer, Grant M et al. (2013) Diffusion of technologies for the care of older adults with exudative age-related macular degeneration. Am J Ophthalmol 155:688-96, 696.e1-2
Hahn, Paul; Acquah, Kofi; Cousins, Scott W et al. (2013) Ten-year incidence of age-related macular degeneration according to diabetic retinopathy classification among medicare beneficiaries. Retina 33:911-9
Day, Shelley; Acquah, Kofi; Mruthyunjaya, Prithvi et al. (2011) Ocular complications after anti-vascular endothelial growth factor therapy in Medicare patients with age-related macular degeneration. Am J Ophthalmol 152:266-72
Lee, Michael S; Grossman, Daniel; Arnold, Anthony C et al. (2011) Incidence of nonarteritic anterior ischemic optic neuropathy: increased risk among diabetic patients. Ophthalmology 118:959-63
Humphreys, Margaret; Costanzo, Philip; Haynie, Kerry L et al. (2007) Racial disparities in diabetes a century ago: evidence from the pension files of US Civil War veterans. Soc Sci Med 64:1766-75
Salm, Martin; Belsky, Daniel; Sloan, Frank A (2006) Trends in cost of major eye diseases to Medicare, 1991 to 2000. Am J Ophthalmol 142:976-82
Williams, Adrienne; Sloan, Frank A; Lee, Paul P (2006) Longitudinal rates of cataract surgery. Arch Ophthalmol 124:1308-14
Reeves, Sherman W; Sloan, Frank A; Lee, Paul P et al. (2006) Uveitis in the elderly: epidemiological data from the National Long-term Care Survey Medicare Cohort. Ophthalmology 113:307.e1
Sloan, Frank A; Picone, Gabriel; Brown, Derek S et al. (2005) Longitudinal analysis of the relationship between regular eye examinations and changes in visual and functional status. J Am Geriatr Soc 53:1867-74

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