Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
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| Measure Information | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period | 2026 Performance Period |
|---|---|---|---|---|
| Title | Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation | Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation | Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation | Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation |
| CMS eCQM ID | CMS143v11 | CMS143v12 | CMS143v13 | CMS143v14 |
| CBE ID* | 0086e | 0086e | 0086e | 0086e |
| MIPS Quality ID | 012 | 012 | 012 | 012 |
| Measure Steward | American Academy of Ophthalmology | American Academy of Ophthalmology | American Academy of Ophthalmology | American Academy of Ophthalmology |
| Description |
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 visits within 12 months |
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 visits within 12 months |
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 visits within 12 months |
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 visits during the measurement period |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS143v11.html |
None |
None |
None |
| Risk Adjustment | *See CMS143v11.html |
None |
None |
None |
| Rationale | *See CMS143v11.html |
Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. In 2011, 2.71 million persons in the U.S. had primary open-angle glaucoma (POAG) and in 2050, an estimated 7.32 million persons will have POAG (Vajaranant, Wu, Torres, & Varma, 2012). Furthermore, a study by Rein, Zhang, & Wirth (2006) estimated that the total financial burden of major visual disorders among U.S. residents aged 40 years or older was $35.4 billion in 2004: $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses. Of the direct medical costs, approximately $2.9 billion was attributable to glaucoma (Rein, Zhang, & Wirth, 2006). It is imperative that evidence-based care be delivered to all glaucoma patients. According to recent guidelines, optic nerve changes are one of the characteristics which reflect progression of glaucoma (the other characteristic is visual field). Examination of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) provides valuable structural information about optic nerve damage from glaucoma. Visible structural alterations of the ONH or RNFL may precede the onset of visual field defects. Careful study of the optic disc neural rim for small hemorrhages is important because these hemorrhages sometimes signal focal disc damage and visual field loss, and they may signify ongoing optic nerve damage in patients with glaucoma (Gedde et al., 2021). Despite evidence emphasizing the value of an optic nerve evaluation, there is a gap in documentation patterns of the optic nerve for both initial and follow-up care. This measure is intended to promote examination and documentation of the structure and function of the optic nerve, and to monitor and detect disease progression among patients diagnosed with POAG. |
Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. In 2011, 2.71 million persons in the U.S. had primary open-angle glaucoma (POAG) and in 2050, an estimated 7.32 million persons will have POAG (Vajaranant, Wu, Torres, & Varma, 2012). Furthermore, a study by Rein, Zhang, & Wirth (2006) estimated that the total financial burden of major visual disorders among U.S. residents aged 40 years or older was $35.4 billion in 2004: $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses. Of the direct medical costs, approximately $2.9 billion was attributable to glaucoma (Rein, Zhang, & Wirth, 2006). It is imperative that evidence-based care be delivered to all glaucoma patients. According to recent guidelines, optic nerve changes are one of the characteristics which reflect progression of glaucoma (the other characteristic is visual field). Examination of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) provides valuable structural information about optic nerve damage from glaucoma. Visible structural alterations of the ONH or RNFL may precede the onset of visual field defects. Careful study of the optic disc neural rim for small hemorrhages is important because these hemorrhages sometimes signal focal disc damage and visual field loss, and they may signify ongoing optic nerve damage in patients with glaucoma (Gedde et al., 2021). Despite evidence emphasizing the value of an optic nerve evaluation, there is a gap in documentation patterns of the optic nerve for both initial and follow-up care. This measure is intended to promote examination and documentation of the structure and function of the optic nerve, and to monitor and detect disease progression among patients diagnosed with POAG. |
Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. In 2011, 2.71 million persons in the U.S. had primary open-angle glaucoma (POAG) and in 2050, an estimated 7.32 million persons will have POAG (Vajaranant, Wu, Torres, & Varma, 2012). Furthermore, a study by Rein, Zhang, & Wirth (2006) estimated that the total financial burden of major visual disorders among U.S. residents aged 40 years or older was $35.4 billion in 2004: $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses. Of the direct medical costs, approximately $2.9 billion was attributable to glaucoma (Rein, Zhang, & Wirth, 2006). It is imperative that evidence-based care be delivered to all glaucoma patients. According to recent guidelines, optic nerve changes are one of the characteristics which reflect progression of glaucoma (the other characteristic is visual field). Examination of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) provides valuable structural information about optic nerve damage from glaucoma. Visible structural alterations of the ONH or RNFL may precede the onset of visual field defects. Careful study of the optic disc neural rim for small hemorrhages is important because these hemorrhages sometimes signal focal disc damage and visual field loss, and they may signify ongoing optic nerve damage in patients with glaucoma (Gedde et al., 2021). Despite evidence emphasizing the value of an optic nerve evaluation, there is a gap in documentation patterns of the optic nerve for both initial and follow-up care. This measure is intended to promote examination and documentation of the structure and function of the optic nerve, and to monitor and detect disease progression among patients diagnosed with POAG. |
| Clinical Recommendation Statement | *See CMS143v11.html |
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 (Gedde et al., 2021) The optic nerve should be carefully examined for the signs of glaucoma damage, and its appearance should be serially documented (I+, moderate quality, strong recommendation) (Gedde et al., 2021). |
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 (Gedde et al., 2021) The optic nerve should be carefully examined for the signs of glaucoma damage, and its appearance should be serially documented (I+, moderate quality, strong recommendation) (Gedde et al., 2021). |
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 (Gedde et al., 2021) The optic nerve should be carefully examined for the signs of glaucoma damage, and its appearance should be serially documented (I+, moderate quality, strong recommendation) (Gedde et al., 2021). |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS143v11.html |
None |
None |
None |
| Guidance |
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 SNOMED-CT does 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. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
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 SNOMED-CT does 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. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
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 SNOMED-CT does 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 clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
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 SNOMED-CT does 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 clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma |
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma |
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma |
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
None |
None |
None |
None |
| Numerator |
Patients who have an optic nerve head evaluation during one or more visits within 12 months |
Patients who have an optic nerve head evaluation during one or more visits within 12 months |
Patients who have an optic nerve head evaluation during one or more visits within 12 months |
Patients who have an optic nerve head evaluation during one or more visits during the measurement period |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
None |
| Denominator Exceptions |
Documentation of medical reason(s) for not performing an optic nerve head evaluation |
Documentation of medical reason(s) for not performing an optic nerve head evaluation |
Documentation of medical reason(s) for not performing an optic nerve head evaluation |
Documentation of medical reason(s) for not performing an optic nerve head evaluation |
| Telehealth Eligible | No | No | No | No |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS143v14
Header
TRN | Measure Section | Source of Change |
|---|---|---|
Changed the 'eCQM Identifier (Measure Authoring Tool)' field name to 'CMS ID' based on tooling updates. | CMS ID | Standards/Technical Update |
Updated the eCQM version number. | eCQM Version Number | Annual Update |
Updated the generic measurement period from 'January 1, 20XX through December 31, 20XX' to specify 'January 1, 2026 through December 31, 2026' based on tooling updates. | Measurement Period | Standards/Technical Update |
Removed 'PCPI(R) Foundation (PCPI[R])' as a Measure Developer to reflect active Measure Developers. | Measure Developer | Annual Update |
Updated the measure description to clarify that the measure only evaluates whether an optic nerve head evaluation is performed during the measurement period. | Description | Measure Lead |
Updated copyright. | Copyright | Annual Update |
Updated disclaimer | Disclaimer | Annual Update |
Updated the numerator to clarify that the measure only evaluates whether an optic nerve head evaluation is performed during the measurement period. | Numerator | Measure Lead |
Changed 'Numerator Exclusions' field to read 'None' instead of 'Not Applicable' when no exclusions are present. | Numerator Exclusions | Standards/Technical Update |
Logic
TRN | Measure Section | Source of Change |
|---|---|---|
Updated Measure Primary CQL Library Name from 'POAGOpticNerveEvaluation' to 'CMS143POAGOpticNerveEvaluationQDM' for alignment with the CQL Style Guide. | Definitions | Standards/Technical Update |
Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.' | Definitions | Annual Update |
Updated the timing comparison precision in the definitions by adding 'day of' operator to align with the measure intent and address time zone differences. | Definitions | Annual Update |
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide. | Definitions | Standards/Technical Update |
Updated Measure Primary CQL Library Name from 'POAGOpticNerveEvaluation' to 'CMS143POAGOpticNerveEvaluationQDM' for alignment with the CQL Style Guide. | Functions | Standards/Technical Update |
Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.' | Functions | Annual Update |
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
TRN | Measure Section | Source of Change |
|---|---|---|
Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 1 SNOMEDCT code (185349003) based on review by technical experts, SMEs and/or public feedback. | Terminology | Annual Update |
Replaced Value Set 'ONC Administrative Sex' (2.16.840.1.113762.1.4.1) with Value Set 'Federal Administrative Sex' (2.16.840.1.113762.1.4.1021.121) to represent Supplemental Data Element 'SDE Sex' based on revised standards. | Terminology | Standards/Technical Update |
Value Set ‘Primary Open Angle Glaucoma’ (2.16.840.1.113883.3.526.3.326): Added 7 SNOMEDCT codes (306287007, 1306288002, 1306289005, 1231243004, 1306884006, 1306885007, 1306886008) based on code system/terminology updates. Deleted 2 SNOMEDCT codes (15633321000119108, 15640441000119104) based on code system/terminology updates. | Terminology | Annual Update |