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  • Limited Vitrectomy Is Cost-Effective for Myodesopsia

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, August 2019

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    Rostami et al. looked at the cost-effec­tiveness of limited vitrectomy as treat­ment for vision-degrading myodesop­sia. They found that the procedure is effective both clinically and econom­ically. It improved contrast sensitivity function (CSF) and visual acuity, and its cost-utility ratio (when compared to no treatment) exceeded that of cataract surgery, retinal detachment repair, and treatments for other eye disorders.

    This study was a retrospective interventional case series in which third-party payer costs were analyzed. The researchers included 67 patients with unilateral vitreous floaters; of these, 20 were nonmyopes with posteri­or vitreous detachment (PVD), 17 were myopes without PVD, and 30 were my­opes with PVD. Participants completed the NEI Visual Function Questionnaire (NEI VFQ-39). Best-corrected visual acuity (BCVA) and CSF were assessed before and after limited vitrectomy, and a cost-utility analysis was performed.

    After vitrectomy, the mean VFQ-39 score increased 19% (p < .00001). Gen­eral vision improved by 27% among the entire group (p < .00001) and by 37% in those with nonmyopic PVD (p < .00001 for each). NEI VFQ-39 correlations with time trade-off utilities indicated that quality of life improved 14.4%. BCVA improved 13.5% (p < .00001), and CSF improved 53% (p < .00001). The incremental patient value gain from limited vitrectomy was 2.38 quality adjusted life-years (QALYs), and the average cost-utility ratio in 2018 U.S. dollars was $1,574 per QALY.

    The fact that myopes without PVD had the lowest cost-utility ratio of the subgroups ($1,338/QALY) should help to guide case selection, the authors said. Larger studies of longer duration are needed to capture adverse events and to draw conclusions about the cost-utility of this procedure relative to that of treatments for other eye conditions.

    The original article can be found here.