Objective: To estimate impacts of physician-diagnosed eye diseases (age-related macular degeneration (AMD), cataract, diabetic retinopathy, and glaucoma) on Medicare payments in the periods 1991 to 1995 and 1996 to 2000.

Methods: A retrospective cohort study to estimate program payments per capita and in total for each of the major eye diseases and the four eye diseases in total. Methods: Data from the 1994 and 1999 National Long-Term Care Survey (NLTCS) and medical claims to Medicare from 1991 to 2000 were merged with the NLTCS. Medicare payments for eye-related procedures on persons with and without major eye diseases as reported on Medicare claims and self-reported data from NLTCS.

Results: Overall, the burden of major eye diseases was to increase Medicare spending by 4.8 billion dollars (1999 USD) in 1991 to 1995 and by 4.5 billion dollars in 1996 to 2000. The most expensive eye disease was cataract, costing Medicare 3.8 billion dollars in 1991 to 1995 and 3 billion dollars in 1996 to 2000.

Conclusions: Prevalence of major eye diseases increased over time, but the effect of major eye diseases on Medicare payments decreased, mainly as a result of lower payments for cataract surgery in the later years.