Purpose To evaluate the risk of developing Alzheimer’s disease (AD) or other dementia in patients diagnosed with open-angle glaucoma (OAG) in a nationally representative longitudinal sample of elderly persons. Methods This is a longitudinal retrospective cohort study (January 1, 1994 – December 31, 2007) that used Medicare 5% claims data. We identified beneficiaries aged 68+ years who had at least 2 claims with diagnoses of OAG and no Alzheimer’s or other dementia in 1994, using a 3 year look-back period between 19911993 (n = 63,235) and beneficiaries matched on age, sex, race, and Charlson index without a diagnosis of OAG throughout the observational period (n = 63,235) using propensity score matching. Using a Cox Proportional Hazards model, we analyzed time to Alzheimer’s disease diagnosis and time to Alzheimer’s disease or other dementia diagnosis. Results Elderly individuals diagnosed with OAG did not have an increased rate of AD and other dementia diagnosis compared to those without OAG during a 14-year follow-up period, even after controlling for relevant covariates present at baseline. Conclusions Individuals aged 68+ years diagnosed with OAG have a decreased rate of AD or other dementia diagnosis compared to control patients without an OAG diagnosis. Although OAG and AD are both age-related neurodegenerative diseases, our findings do not support a positive association.

Purpose To determine longitudinal rates of ocular complications after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) in a nationally representative longitudinal sample. Design retrospective, longitudinal case-control study. Methods Using the Medicare 5% claims database, diagnoses of neovascular AMD and anti-VEGF injections of ranibizumab, bevacizumab, or pegaptanib were identified from International Classification of Diseases (ICD-9-CM) and Current Procedural Terminology (CPT) procedure codes. 6,154 individuals undergoing anti-VEGF treatment for neovascular AMD (total of 40,903 injections) were compared with 6,154 matched controls with neovascular AMD who did not undergo anti-VEGF treatment. Propensity score matching was used to match individuals receiving anti-VEGF injections with controls. Rates of post-injection adverse outcomes (endophthalmitis, rhegmatogenous retinal detachment, retinal tear, uveitis, and vitreous hemorrhage) were analyzed by cumulative incidence and Cox proportional hazards model to control for demographic factors and ocular comorbidities. Results At 2-year follow-up, the rates of endophthalmitis per injection (0.09%; p<0.01), uveitis (0.11%; p<0.01), and vitreous hemorrhage per injection (0.23%; p<0.01) were significantly higher in the anti-VEGF treatment group. With Cox proportional hazards modeling, the anti-VEGF treatment group had an 102% higher risk of severe ocular complications overall, and a 4% increased risk per injection, both of which were statistically significant (p<0.01) Conclusions Rates of endophthalmitis, uveitis, and vitreous hemorrhage were higher in the group treated with anti-VEGF injection than in the control group, though nevertheless rare in both groups. The overall risk of severe ocular complications was significantly higher in the anti-VEGF treatment group.

Purpose To determine rates and risk factors associated with severe post-operative complications following cataract surgery and whether they have been changing over the past decade. Design Retrospective longitudinal cohort study Participants 221,594 Medicare beneficiaries who underwent cataract surgery during 1994–2006. Methods Beneficiaries were stratified into 3 cohorts, those who underwent initial cataract surgery during 1994-5, 1999–2000, or 2005-6. One year rates of post-operative severe adverse events (endophthalmitis, suprachoroidal hemorrhage, retinal detachment) were determined for each cohort. Cox regression analyses determined the hazard of developing severe adverse events for each cohort with adjustment for demographic factors, ocular and medical conditions, and surgeon case-mix. Main Outcome Measures Time period rates of development of severe post-operative adverse events. Results Among the 221,594 individuals who underwent cataract surgery, 0.5% (1,086) had at least one severe post-operative complication. After adjustment for confounders, individuals who underwent cataract surgery during 1994-5 had a 21% increased hazard of being diagnosed with a severe post-operative complication (Hazard Ratio (HR): 1.21; [95% Confidence Interval (CI): 1.05–1.41]) relative to individuals who underwent cataract surgery during 2005-6. Those who underwent cataract surgery during 1999–2000 had a 20% increased hazard of experiencing a severe complication (HR: 1.20 [95% CI: 1.04–1.39]) relative to the 2005-6 cohort. Risk factors associated with severe adverse events include a prior diagnosis of proliferative diabetic retinopathy (HR: 1.62 [95% CI: 1.07–2.45]) and cataract surgery combined with another intraocular surgical procedure on the same day (HR: 2.51 [95% CI: 2.07–3.04]). Individuals receiving surgery by surgeons with the case-mix least prone to developing a severe adverse event (HR: 0.52 [95% CI: 0.44–0.62]) had a 48% reduced hazard of a severe adverse event relative to recipients of cataract surgery performed by surgeons with the case-mix most prone to developing such outcomes. Conclusion Rates of sight-threatening adverse events following cataract surgery declined during 1994–2006. Future efforts should be directed to identifying ways to reduce severe adverse events in high-risk groups.

Public health insurance programs comprise a large share of federal and state government expenditures. Although a sizable literature analyzes the effects of these programs on health care utilization and health outcomes, little prior work has examined the long-term effects and resultant health improvements on important outcomes, such as educational attainment. We contribute to filling this gap in the literature by examining the effects of the public insurance expansions among children in the 1980s and 1990s on their future educational attainment. Our findings indicate that expanding health insurance coverage for low-income children increases the rate of high school completion and college completion. These estimates are robust to only using federal Medicaid expansions, and mostly are due to expansions that occur when the children are older (i.e., not newborns). We present suggestive evidence that better health is one of the mechanisms driving our results by showing that Medicaid eligibility when young translates into better teen health. Overall, our results indicate that the long-run benefits of public health insurance are substantial.

Objective-Previous studies have identified a higher prevalence of diabetes mellitus (DM) among patient cohorts with non-arteritic anterior ischemic optic neuropathy (NAION). We sought to determine the development of incident NAION among a group of newly diagnosed patients with DM and to estimate the incidence of NAION among the elderly.Design-Medicare 5% database study. Participants-25,515 patients with DM and an equal number of age-and gender-matched nondiabetics.Methods-Query of Medicare 5% claims files identified patients with new diagnosis of DM in 1994. A randomly selected control group was created using one-to-one propensity score matching. Patients with a diagnosis of giant cell arteritis, pre-existing DM, and age < 68 years or > 95 years were excluded. Patients with DM and controls were followed for the development of NAION over the following 4,745 days.Main Outcome Measures-Incidence of anterior ischemic optic neuropathy (AION) among patients with and without DM.Results-Each group was 85% White, 11% Black, and 4% other race, aged 76.4 years, and 40% male with a mean followup time of 7.6 years. In the diabetes group, 188 individuals developed AION (0.7%) compared to 131 individuals (0.5%; p<0.01) in the control group. In unadjusted Cox regression analysis, having diabetes mellitus was associated with a 43% increased risk (Hazard ratio [HR] Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2012 May 1. Conclusions-DM significantly increased the risk of the diagnosis NAION. The incidence of NAION among patients older than 67 years may be higher than previously reported.Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute, optic neuropathy among individuals over the age of 50 years with an estimated annual incidence of 2.3 -10.2/100,000 in the United States (U.S.).1 , 2 These estimates are based on small local studies and then extrapolated to the U.S. population.The exact pathophysiology of NAION remains unknown, but numerous risk factors have been proposed based on retrospective observations of relatively small groups of patients. The most commonly cited risk factors suggest vasculopathic disorders such as diabetes mellitus (DM), 3 -6 systemic hypertension,4 -7 hyperlipidemia,7 -9 and smoking. 8 , 10 , 11 Each of these factors has been disputed,12 and, in many cases, a study identified one risk factor and discounted another. 3 -9 Diabetes mellitus has the highest prevalence among patients with NAION, however to our knowledge, the incidence of NAIO...