Visual Impairment, Treatment and Effects on the Elderly

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Summary of work This 3-year study has 3 specific aims: (1) Examine patterns of longitudinal use of eye care diagnostic and therapeutic services for major eye diseases; (2) Assess whether visual loss has been reduced by new innovations in ocular therapy for age-related macular degeneration (AMD) and greater intensity of therapy in diabetic eye diseases (both systemic and ocular); and (3) Assess utilization, conformance with guidelines, and cardiovascular, cerebrovascular, and nephropathy outcomes. Aim 1 investigates hyperbolic discounting as an explanation of nonuse and diffusion of new therapies for treatment of AMD. Aim 2 performs comparative effectiveness analysis of effects of AMD therapies and diabetic eye therapies on visual and other complications. Aim 3 investigates effects of diagnostic and therapeutic procedures, including prescribed drugs, on cardiovascular, cerebrovascular, and nephropathy outcomes using instrumental variable (IV) and control function methods. To complement the IV analysis, this study investigates the process of selection into care, assessing roles of such observables as clinical, demographic and financial factors on selection. National, longitudinal data bases to be used include: Medicare 5% claims data merged with vital statistics information from 1991-2010; Health and Retirement Survey data on Medicare beneficiaries merged with Medicare claims for 1993-2008; and Medicare Current Beneficiary Survey data also merged with administrative information from Medicare, 1991-2009.