ABSTRACT
PURPOSE: To investigate changes in the proportion of patients with age-related macular degeneration (AMD) visiting hospitals and to investigate factors associated with AMD, treatments, and medical expenses, as well as the outlook for AMD in Japan using a large health insurance database. DESIGN: Analysis of national insurance claims data. PARTICIPANTS: People 40 years of age or older who were registered in the Japan Medical Data Center database. METHODS: Patients with AMD were identified from 2005 through 2013 based on International Classification of Diseases, 10th revision, diagnosis codes. Changes in patient proportions, treatment procedures, and medical expenses were investigated during the study period. The data for each year were compared after adjustment based on the 2010 Japanese population annual census. The outlook for patients with AMD was predicted based on the combination of data in 2013 and an official future population prediction report. MAIN OUTCOME MEASURES: Changes in treatment patterns and health care costs in Japan. RESULTS: A total of 3â401â299 participants were included in the analysis, and 3058 AMD patients were identified over the 9-year period. The proportion of patients with AMD increased significantly from 0.084% (95% confidence interval, 0.050%-0.119%) in 2005 to 0.26% (95% confidence interval, 0.24%-0.29%) in 2013 (P = 0.0001, Pearson correlation coefficient test). There were significantly more men than women (odds ratio, 1.25; 95% confidence interval, 1.14-1.37), and the proportion of patients with AMD increased rapidly with age. Photodynamic therapy was replaced by anti-vascular endothelial growth factor (VEGF) therapy as the predominant therapy from 2009 onward. Medical expenses per 10â000 persons increased from $1530 to $137â000 over the 9-year period. The proportion of AMD patients is predicted to increase in the future and will reach a maximum of 223â000 in 2035. CONCLUSIONS: The proportion of AMD patients visiting hospitals, medical expenses, and the frequency of anti-VEGF therapy increased significantly over the 9-year period. These increasing trends are predicted to continue in Japan.
Subject(s)
Health Care Costs/trends , Macular Degeneration/economics , Macular Degeneration/therapy , National Health Programs/statistics & numerical data , Practice Patterns, Physicians'/trends , Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Databases, Factual , Female , Health Care Costs/statistics & numerical data , Health Services Research , Humans , Japan , Male , Middle Aged , Photochemotherapy/trends , Practice Patterns, Physicians'/statistics & numerical data , Registries , Sex DistributionSubject(s)
Choroid Diseases/chemically induced , Diabetic Retinopathy/drug therapy , Glucocorticoids/adverse effects , Macular Edema/drug therapy , Retinal Diseases/chemically induced , Triamcinolone Acetonide/adverse effects , Vitrectomy , Blood , Cataract Extraction , Choroid Diseases/diagnosis , Female , Fluorescein Angiography , Humans , Injections , Laser Coagulation , Lens Implantation, Intraocular , Middle Aged , Retinal Diseases/diagnosis , Tomography, Optical CoherenceABSTRACT
PURPOSE: To report the clinical course and images of optical coherence tomography of an eye with a stage 2 macular hole which closed spontaneously. DESIGN: Observational case report. METHODS: Serial optical coherence tomographic images were obtained. RESULTS: A 67-year-old woman received a diagnosis of stage 2 idiopathic macular hole in her right eye. The diagnosis was made with a tomographic image of a full-thickness dehiscence of the neurosensory retina at the fovea. The posterior hyaloid membrane was adhering to the edge of the dehiscence. Four weeks later, the closure of the macular hole was ascertained with optical coherence tomography. The posterior hyaloid membrane was fully separated from the fovea. CONCLUSION: A stage 2 macular hole may close spontaneously with the separation of the hyaloid membrane.
