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 visits within 12 months

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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 (American Academy of Ophthalmology, 2015). 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.

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
(American Academy of Ophthalmology, 2015)

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) (American Academy of Ophthalmology, 2015).

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'American Academy of Ophthalmology (2015). Primary open-angle glaucoma Preferred Practice Pattern. San Francisco, CA: American Academy of Ophthalmology.'

Reference Type: CITATION

Reference Text: 'Rein, D. B., Zhang, P., & Wirth, K. (2006). The economic burden of major adult visual disorders in the United States. Archives of Ophthalmology, 124(12), 1754-1760. doi:10.1001/archopht.124.12.1754'

Reference Type: CITATION

Reference Text: 'Vajaranant, T. S., Wu, S., Torres, M., & Varma, R. (2012). The changing face of primary open-angle glaucoma in the United States: Demographic and geographic changes from 2011 to 2050. American Journal of Ophthalmology, 154(2). doi:10.1016/j.ajo.2012.02.024'

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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 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 eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

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 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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