Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months

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Changes in the optic nerve are one of two characteristics which currently define progression and thus worsening of glaucoma disease status (the other characteristic is visual field). There is a significant gap in documentation patterns of the optic nerve for both initial and follow-up care (Fremont, 2003), even among specialists (Lee, 2006). Examination of the optic nerve head and retinal nerve fiber layer provides valuable structural information about glaucomatous optic nerve damage. Visible structural alterations of the optic nerve head or retinal nerve fiber layer and development of peripapillary choroidal atrophy frequently occur before visual field defects can be detected. Careful study of the optic disc neural rim for small hemorrhages is important, since these hemorrhages can precede visual field loss and further optic nerve damage.

When initiating therapy, the clinician sets a target range of controlled intraocular pressure (IOP) based on the pretreatment pressure and the presence of optic nerve damage. According to the AAO Glaucoma Preferred Practice Pattern, lowering the pretreatment IOP reduces the risk of developing POAG and slows the progression of POAG to preserve visual function (AAO, 2015).

Ophthalmic Evaluation
The ophthalmic evaluation specifically focuses on the following elements in the comprehensive adult medical eye evaluation:

Visual acuity measurement
Pupil examination
Anterior segment examination
IOP measurement
Gonioscopy
Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) examination
Fundus examination
(AAO, 2015)

Higher score indicates better quality

American Academy of Ophthalmology Glaucoma Panel. Preferred Practice Pattern Guidelines. Primary Open-Angle Glaucoma. San Francisco, CA: American Academy of Ophthalmology; 2015. Available at: www.aao.org/ppp

Fremont AM, et al. Patterns of Care for Open-angle Glaucoma in Managed Care. Arch Ophthalmol. 2003;121:777-783.

Lee PP, et al. A Multicenter, Retrospective Pilot Study of Resource Use and Costs Associated With Severity of Disease in Glaucoma. Arch Ophthalmol. 2006;124:12-19.

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Optic nerve head evaluation includes examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities. Both of these components of the optic nerve head evaluation are examined using ophthalmoscopy.

The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.

TBD

All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma

Equals Initial Population

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Patients who have an optic nerve head evaluation during one or more office visits within 12 months

Not Applicable

Documentation of medical reason(s) for not performing an optic nerve head evaluation

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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