Correlation of Retinal Imaging Utilization with Anti-Vascular Endothelial Growth Factor and Panretinal Photocoagulation Usage from 2013-2021.

Purpose: To analyze trends in retinal imaging utilization and assess whether there is a correlation with anti-vascular endothelial growth factor (anti-VEGF) and panretinal photocoagulation (PRP) usage.

Methods: We performed a cross-sectional study utilizing the publicly available Medicare Physician & Other Practitioners - by Provider and Service database. Data were identified using procedural codes for ocular coherence tomography (OCT), fundus photography (FP), fluorescein angiography (FA), ICGA (indocyanine green angiography), ophthalmic ultrasound (US), intravitreal anti-VEGF agents, and PRP from 2013-2021. Time-based analyses were also conducted for the individual periods 2013-2016 and 2017-2021 in order to account for changes in the billing of FA from unilateral to unilateral or bilateral after 2016.

Results: While OCT increased in relative utilization (p < 0.001 across 2013-2021, 2013-2016, and 2017-2021), there was a decline in relative utilization for FA, FA+ICGA, US, and FP (p < 0.001 for all modalities across 2013-2021, 2013-2016, and 2017-2021). For PRP, positive associations in annual volume were observed with FA (p < 0.001, R2 = 0.81) and FA+ICGA (p < 0.001, R2 = 0.87), while a negative association in annual volume was observed with OCT (p = 0.028, R2 = 0.52). For anti-VEGF injections, a positive association in annual volume was observed with OCT (p < 0.001, R2 = 0.84), while negative associations were observed with FA (p < 0.001, R2 = 0.89) and FA+ICGA (p < 0.001, R2 = 0.90). Although anti-VEGF use returned to 2019 levels by 2021, PRP use declined by 30% during the same time period.

Conclusion: OCT continues to rise as a percentage of all retinal imaging ordered, while FA has declined. This trend corresponds to an increase in anti-VEGF injections and a decline in PRP in the treatment of retinal diseases.