American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry and the IRIS Registry Analytic Center Consortium

U.S. Incidence and Demographics of Ocular Surface Squamous Neoplasia in the IRIS® Registry (Intelligent Research in Sight) 2014-2021

PURPOSE

To determine the incidence and demographics of ocular surface squamous neoplasia (OSSN) in the U.S. using the IRIS® Registry (Intelligence Research in Sight).

DESIGN

Retrospective analysis of all patients with OSSN International Classification of Disease (ICD) 9th and 10th revision codes PARTICIPANTS: 13,924 unique eyes from 13,383 patients METHODS: ICD 9th and 10th revision codes were used to identify eyes with OSSN MAIN OUTCOME MEASURES: Incidence of OSSN, demographic information, diagnosis, risk factors, and frequency of use for current treatments RESULTS: Annual incidence from 2014-2021 in the IRIS® Registry was 3.4 per 100,00 patient-years. The incidence within the registry of OSSN increased 2.9x from 2014 to 2021. The average age was 67 years with 87% of patients older than 50 years and 62% older than 65 years. Demographics of the affected cohort were 63% male, 65% White and 10% Hispanic. Forty percent of OSSN patients had a history of smoking, and 39% of patients were in southern U.S. states based on U.S. Census classification. Surgical excision was performed on 44% of OSSN eyes. Of the patients with primary topical therapy, 61% were treated with interferon alfa-2b (IFN).

CONCLUSIONS

This is the first study to use the IRIS® Registry as a database for the incidence and demographics of OSSN. Our demographic results are consistent with other studies showing a higher incidence in older, White, and male patients. This study demonstrated that as of 2021 there are at least 2,100 new OSSN cases per year in the U.S and that incidence increased from 2014-2021. The use of the topical immuno-chemotherapy IFN remained a popular treatment modality for OSSN from 2014 through 2021.

Factors Associated with Retinal Detachment after Pediatric Cataract Surgery in the IRIS® Registry

PURPOSE

This study leverages the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) to identify factors associated with retinal detachment (RD) after pediatric cataract surgery.

DESIGN

Retrospective cohort study.

PARTICIPANTS

All children (age < 18 years) who underwent cataract surgery between January 2013 and December 2020 at practices that participate in the IRIS Registry.

METHODS

Data collected included patient demographics and medical history. Current Procedural Terminology codes were used to identify procedures for cataract surgery and RD repair. International Classification of Disease codes were used to classify diagnoses such as degenerative high myopia, persistent fetal vasculature, retinopathy of prematurity, ocular trauma, and retinal detachment. The Kaplan-Meier estimator was used to determine the cumulative incidence of retinal detachment diagnosis and repair after cataract surgery. Hazard ratios with 95% confidence intervals were calculated using multivariable Cox regression models.

MAIN OUTCOME MEASURES

Cumulative incidence of RD diagnosis and repair within 5 years of cataract surgery.

RESULTS

Seven thousand four hundred seven children (53% male, 49% White non-Hispanic) were identified and included. The cumulative incidence of retinal detachment diagnosis and repair after cataract surgery was 3.8% (95% CI, 3.1%-4.5%) and 1.6% (95% CI, 1.2%-2.0%), respectively. Children with a history of ocular trauma (hazard ratio [HR], 2.22; 95% CI 1.39-3.57; P < 0.001), aphakia (HR, 2.10; 95% CI, 1.43-3.10; P < 0.001), premature retina (HR 2.73; 95% CI, 1.36-5.48; P = 0.005), persistent fetal vasculature (HR, 3.26; 95% CI, 1.58-6.71; P = 0.001), and Hispanic ethnicity (HR, 1.71; 95% CI, 1.15-2.54; P = 0.008) were at increased risk of RD diagnosis within 5 years of cataract surgery. Similar risk factors were identified for RD requiring surgical repair.

CONCLUSIONS

Among children undergoing cataract surgery in the IRIS Registry, RD was associated with a history of ocular trauma, aphakia, premature retina, persistent fetal vasculature, and Hispanic ethnicity. Identifying risk factors for complications after cataract surgery is essential to guide preoperative decision-making and long-term monitoring to mitigate RD risk in vulnerable patients.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Intravitreal Antibiotics versus Early Vitrectomy Plus Intravitreal Antibiotics for Postinjection Endophthalmitis: An IRIS® (Intelligent Research in Sight Registry) Analysis

PURPOSE

To determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-VEGF injections.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Patients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry between 2016 and 2020.

METHODS

Inclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and posttreatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis distance matching, accounting for the differences in VA at baseline and diagnosis.

MAIN OUTCOME MEASURES

Posttreatment logarithm of the minimum angle of resolution (logMAR) VA.

RESULTS

A total of 1044 patients diagnosed with postinjection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort, 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 (20/40-20/50) at baseline, 0.88 (∼20/150) at diagnosis, and 0.57 (20/70-20/80) posttreatment. There were no statistically significant differences in the visual outcomes between the 2 matched treatment groups (b = 0.05; P = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05; P = 0.452).

CONCLUSIONS

There was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for postinjection endophthalmitis. The findings support the use of either treatment strategy.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

International Corneal and Ocular Surface Disease Dataset for Electronic Health Records

Background/Aims

To provide a comprehensive and internationally standardised Cornea and Ocular Surface Disease (C&OSD) dataset for use in electronic health records (EHRs).

Methods

This was an international consensus study conducted through roundtable discussions involving 35 international experts specialising in the field of C&OSD. The Royal College of Ophthalmologists dataset guidelines were used to articulate initial C&OSD data elements template by curating data elements from validated published datasets obtained through scientific literature searches, and accessing existing international patient clinical and reported outcome recording instruments and registries. These included data elements recommended by the Dry Eye Workshop II, International Meibomian Gland Dysfunction Workshop, Ocular Surface Disease Activity and Damage Indices, the Cicatrising Conjunctivitis Assessment Tool, Limbal Stem Cell Deficiency Clinical and Confocal Grading, Chronic Ocular Manifestations in Patients with Stevens-Johnson Syndrome, and the UK Transplant Registry. Data elements pooled into an independent operational data model.

Results

A comprehensive generic dataset (common to all ophthalmology datasets) and C&OSD specific dataset was developed. Within the C&OSD dataset, several gateway disease datasets, such as atopic or allergic eye diseases, meibomian gland dysfunction, cicatrising conjunctivitis, chemical injury, dry eye, limbal stem cell deficiency, microbial or infectious keratitis, corneal erosion syndrome, and keratoconus, were established to streamline data entry for clinical audit and research purposes.

Conclusion

A comprehensive C&OSD dataset is provided which can be used by both generalist and specialist ophthalmologists. Adoption of the full dataset by EHR providers will lead to better interoperability and patient care and facilitate international research collaboration.

Corneal Opacity in the United States: An American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) Study

PURPOSE

This study assesses the case frequencies, underlying causes, and vision outcomes in patients with a diagnosis of corneal opacity in the United States.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Patients in the IRIS® Registry (Intelligent Research in Sight) who received a diagnosis of corneal opacity between January 1, 2013, and November 30, 2020.

METHODS

The IRIS Registry contains demographic and clinical data of 79 887 324 patients who sought treatment at eye clinics during the study period. We identified patients with corneal opacity using International Classification of Diseases (ICD), Ninth and Tenth Revisions, codes of 371 (corneal scar) and H17 (corneal opacity), respectively. The analyzed data comprised demographic parameters including age, sex, race, ethnicity, and geographical location. We evaluated clinical data including laterality, cause, disease descriptors, and best-corrected visual acuity (VA) up to 1 year before the onset (± 30 days), at the time of diagnosis, and at 1 year after diagnosis (± 30 days).

MAIN OUTCOME MEASURES

Case frequencies, causes, and vision outcomes in patients with a diagnosis of corneal opacity.

RESULTS

We identified 5 220 382 patients who received a diagnosis of corneal opacity and scars using H17 (ICD, Tenth Revision) and 371.0 (ICD, Ninth Revision) codes over 7 years. The case frequency of corneal opacity during the study period was 6535 cases per 100 000 patients (6.5%). The mean age of the patients was 63.36 ± 18.14 years, and most were female (57.6%). In the cohort, 38.39% and 30.00% of patients had bilateral and unilateral corneal opacity, respectively. Most of the patients affected by corneal opacity were White (69.13%), followed by Black or African American (6.84%). Corneal dystrophies (64.66%) were the most common cause of corneal opacity in the study cohort. Visual acuity of the patients worsened significantly because of corneal opacity (0.46 ± 0.74 logarithm of the minimum angle of resolution [logMAR]) and did not improve to the baseline (0.37 ± 0.68 logMAR) after management (0.43 ± 0.77 logMAR). The multiple linear regression analysis showed worse vision outcomes in female patients (compared with male patients), and Asian, Black or African American, and American Indian or Alaska Native (compared with White) patients. Additionally, worse vision outcomes were observed in patients with opacity associated with corneal malformation, degenerative disorders, edema, injury, and ulcer compared with those with hereditary corneal dystrophy.

CONCLUSIONS

Our study showed that corneal opacity was diagnosed in 6.5% of patients in the IRIS Registry and primarily associated with corneal dystrophies. The final vision outcomes in patients with corneal opacity were significantly worse compared with baseline.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Long-term Treatment Patterns for Diabetic Macular Edema: Up to 6-Year Follow-up in the IRIS® Registry

OBJECTIVE

To characterize anti-VEGF intravitreal therapy (IVT) patterns and long-term visual outcomes among patients with diabetic macular edema (DME) in routine clinical practice in the United States.

DESIGN

Retrospective analysis of the American Academy of Ophthalmology's IRIS® (Intelligent Research in Sight) Registry.

PARTICIPANTS

Treatment-naïve patients with DME (no previous IVT in the past 12 months) initiating anti-VEGF IVT from January 1, 2015, to March 31, 2021.

METHODS

Baseline characteristics, treatment patterns, and long-term visual acuity (VA) outcomes were reported for up to 6 years of follow-up.

MAIN OUTCOME MEASURES

Outcomes included the annualized number of injections, change in VA, and anti-VEGF agents.

RESULTS

A total of 190 345 eyes met the inclusion criteria. After 1 year of anti-VEGF IVT initiation, eyes received a mean of 3.9 (±2.8) injections and gained +3.2 (±16.4) letters of vision. Of the 1236 eyes with year 6 data, eyes received a mean of 2.9 (±2.1) injections in year 6 and gained +0.5 (±19.7) letters from baseline. The number of injections decreased, and injection intervals increased year over year up to 6 years regardless of baseline VA initiation. The average injection interval was 10 weeks in year 1 and increased to 13.2 weeks in year 2 before plateauing in years 3 to 6 (12.6, 12.3, 12.2, and 12.3 weeks, respectively). Improvements in VA from baseline were greatest in eyes that received 5 or more injections each year. At the end of follow-up, eyes with good baseline vision (>20/25) lost vision, whereas those with worse baseline vision (<20/25) gained vision. Although 51.7% of patients with DME discontinued IVT after a mean of 6 months, 32.8% reinitiated anti-VEGF IVT. Worse VA outcomes were associated with patients of Hispanic ethnicity (-1.08; 95% confidence interval: -1.34, -0.83] compared with non-Hispanic), Medicaid insurance (-1.15; 95% confidence interval: -1.48, -0.81 compared with commercial), and older age (-0.06; 95% confidence interval: -0.07, -0.05] each additional year).

CONCLUSIONS

Patients with DME in routine clinical settings receive fewer injections than those in clinical trials and fewer than recommended per the label of US Food and Drug Administration-approved anti-VEGF IVT.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

Comparison of Methods of Clinical Trial Emulation Utilizing Data From the Comparison of AMD Treatment Trial (CATT) and the IRIS® Registry

Purpose

We used exact matching and inverse propensity score weighting (IPSW) using real-world data (RWD) from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) to emulate the 2 pro re nata (prn) treatment arms from the Comparison of AMD Treatment Trial (CATT) and to compare the outcomes of the RWD arms to the 2 monthly treatment arms from the clinical trial.

Design

Retrospective cohort study utilizing deidentified electronic health record registry data and patient-level deidentified clinical trial data.

Subjects

All treatment-naive patient eyes with neovascular age-related macular degeneration treated with ranibizumab or bevacizumab only for 1 year from either the CATT or the IRIS Registry.

Methods

Patients were identified in the IRIS Registry between October 1, 2015 and December 31, 2019. After all nonimaging-based inclusion and exclusion criteria from the CATT were applied, patient eyes receiving bevacizumab or ranibizumab only on a prn basis were identified as the eligible cohort. Exact matching and ISPW was applied based on age, gender, and baseline visual acuity.

Main Outcome Measures

Mean change in visual acuity, in approximated ETDRS letters, between baseline and 1 year for the IRIS Registry prn treatment arms generated by exact matching and IPSW.

Results

We identified 427 eyes treated with ranibizumab prn and 771 eyes treated with bevacizumab prn. Using exact matching, 98% (n = 281) of CATT patient eyes in the bevacizumab monthly treatment arm and 87% (n = 261) of CATT patient eyes in the ranibizumab monthly treatment arm were matched to a patient eye in the IRIS Registry. For the ranibizumab prn treatment arm, patient eyes generated using exact matching gained 1.9 letters and those generated using IPSW gained 2.8 letters (exact matching: 1.9 letters ± 14.0 vs. IPSW: 2.8 letters ± 15.0 letters, P = 0.43). For the bevacizumab prn treatment arm, patient eyes generated using exact matching gained 2.4 letters and those generated using IPSW gained 2.1 letters (exact matching: 2.4 letters ± 15.4 vs. IPSW: 2.1 letters ± 16.0 letters, P = 0.79).

Conclusions

Both exact matching and IPSW produced similar results in emulating the prn treatment arms of the CATT using IRIS Registry data and patient-level clinical trial data. Similar to prior real-world studies, the clinical outcomes were significantly worse in the IRIS Registry treatment arms compared with the clinical trial.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

From real world data to real world evidence to improve outcomes in neuro-ophthalmology

Real-world data (RWD) can be defined as all data generated during routine clinical care. This includes electronic health records, disease-specific registries, imaging databanks, and data linkage to administrative databases. In the field of neuro-ophthalmology, the intersection of RWD and clinical practice offers unprecedented opportunities to understand and treat rare diseases. However, translating RWD into real-world evidence (RWE) poses several challenges, including data quality, legal and ethical considerations, and sustainability of data sources. This review explores existing RWD sources in neuro-ophthalmology, such as patient registries and electronic health records, and discusses the challenges of data collection and standardisation. We focus on research questions that need to be answered in neuro-ophthalmology and provide an update on RWE generated from various RWD sources. We review and propose solutions to some of the key barriers that can limit translation of a collection of data into impactful clinical evidence. Careful data selection, management, analysis, and interpretation are critical to generate meaningful conclusions.

Trends and Sociodemographic Patterns in Keratoconus Management 2015-2020: An American Academy of Ophthalmology IRIS® Registry Analysis

PURPOSE

Investigate trends in keratoconus (KCN) treatment patterns and diagnosis age from 2015 to 2020 and evaluate sociodemographic associations with the treatment approach.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Patients with a new KCN diagnosis from 2015 to 2020 were identified in the Academy IRIS® Registry (Intelligent Research in Sight).

METHODS

Associations between sociodemographic factors and treatment were evaluated using multivariable logistic regression.

MAIN OUTCOME MEASURES

Outcomes included percentages and rates of each treatment (collagen crosslinking [CXL], keratoplasty, or no procedure) from 2015 to 2020, age at diagnosis during this period, and sociodemographic factors associated with treatment type.

RESULTS

A total of 66 199 patients with a new diagnosis of KCN were identified. The percentage of patients undergoing CXL increased from 0.05% in 2015 to 29.5% in 2020 (P = 0.008). The average age (standard deviation) of KCN patients decreased from 44.1 (±16.9) years in 2015 to 39.2 (±16.9) years in 2020 (P < 0.001). In multivariable analyses comparing CXL versus no procedure and keratoplasty versus no procedure, patients undergoing CXL tended to be younger with the odds of having CXL decreasing with increasing age, for example, comparing CXL and no procedure patients, using ages 0-20 years as reference, the odds ratio (OR) (95% confidence interval [CI]) decreased from 0.62 (0.57-0.67; P < 0.0001) for patients aged 21-40 years to 0.03 (0.02-0.04; P < 0.0001) for patients aged > 60 years. Men were more likely than women to have CXL (OR, 1.31; 95% CI, 1.23-1.40; P < 0.0001) and keratoplasty (OR, 1.30; 95% CI, 1.19-1.42; P < 0.0001). Black patients were less likely than White patients to have CXL (OR, 0.70; 95% CI, 0.63-0.77; P < 0.0001) and more likely to have keratoplasty (OR, 2.24; 95% CI, 2.01-2.50; P < 0.0001). Likewise, Hispanic patients had higher odds of CXL (OR, 1.12; 95% CI, 1.00-1.24; P < 0.05) and keratoplasty (OR, 1.29; 95% CI, 1.12-1.50; P < 0.001) compared with non-Hispanic patients. Collagen crosslinking and keratoplasty also varied by region and insurance status.

CONCLUSIONS

A significant increase in use of CXL was noted from 2015 to 2020. Sociodemographic differences in treatment among KCN patients may reflect differences in access, use, or care patterns, and future studies should aim to identify strategies to improve access for all patients.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Big data and electronic health records for glaucoma research

The digitization of health records through electronic health records (EHRs) has transformed the landscape of ophthalmic research, particularly in the study of glaucoma. EHRs offer a wealth of structured and unstructured data, allowing for comprehensive analyses of patient characteristics, treatment histories, and outcomes. This review comprehensively discusses different EHR data sources, their strengths, limitations, and applicability towards glaucoma research. Institutional EHR repositories provide detailed multimodal clinical data, enabling in-depth investigations into conditions such as glaucoma and facilitating the development of artificial intelligence applications. Multicenter initiatives such as the Sight Outcomes Research Collaborative and the Intelligent Research In Sight registry offer larger, more diverse datasets, enhancing the generalizability of findings and supporting large-scale studies on glaucoma epidemiology, treatment outcomes, and practice patterns. The All of Us Research Program, with a special emphasis on diversity and inclusivity, presents a unique opportunity for glaucoma research by including underrepresented populations and offering comprehensive health data even beyond the EHR. Challenges persist, such as data access restrictions and standardization issues, but may be addressed through continued collaborative efforts between researchers, institutions, and regulatory bodies. Standardized data formats and improved data linkage methods, especially for ophthalmic imaging and testing, would further enhance the utility of EHR datasets for ophthalmic research, ultimately advancing our understanding and treatment of glaucoma and other ocular diseases on a global scale.

Sociodemographic and Visual Outcomes of Juvenile Idiopathic Arthritis Uveitis: IRIS® Registry Study

Purpose

Understanding sociodemographic factors associated with poor visual outcomes in children with juvenile idiopathic arthritis-associated uveitis may help inform practice patterns.

Patients and Methods

Retrospective cohort study on patients <18 years old who were diagnosed with both juvenile idiopathic arthritis and uveitis based on International Classification of Diseases tenth edition codes in the Intelligent Research in Sight Registry through December 2020. Surgical history was extracted using current procedural terminology codes. The primary outcome was incidence of blindness (20/200 or worse) in at least one eye in association with sociodemographic factors. Secondary outcomes included cataract and glaucoma surgery following uveitis diagnosis. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazards models.

Results

Median age of juvenile idiopathic arthritis-associated uveitis diagnosis was 11 (Interquartile Range: 8 to 15). In the Cox models adjusting for sociodemographic and insurance factors, the hazard ratios of best corrected visual acuity 20/200 or worse were higher in males compared to females (HR 2.15; 95% CI: 1.45-3.18), in Black or African American patients compared to White patients (2.54; 1.44-4.48), and in Medicaid-insured patients compared to commercially-insured patients (2.23; 1.48-3.37).

Conclusion

Sociodemographic factors and insurance coverage were associated with varying levels of risk for poor visual outcomes in children with juvenile idiopathic arthritis-associated uveitis.

Real-World Safety Outcomes with Brolucizumab in Neovascular Age-Related Macular Degeneration: Findings from the IRIS® Registry

INTRODUCTION

To assess real-world safety outcomes for adults with neovascular age-related macular degeneration (nAMD) treated with brolucizumab from the US-based IRIS® (Intelligent Research in Sight) Registry.

METHODS

In this retrospective study, 18,312 eyes (15,998 patients) treated with ≥ 1 intravitreal brolucizumab injections between 8 October 2019 (US launch date for brolucizumab) and 7 October 2021 were followed up for ≤ 2 years after first injection (index date). The study assessed the predefined incident ocular adverse events of intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RO).

RESULTS

Overall, 614/18,312 eyes (3.4%) experienced any IOI, RV, and/or RO event. Median (interquartile range [IQR]) time to an event was 84 (42-167) days; 77.4% of events (475/614) occurred within 6 months after index date. Median (IQR) number of brolucizumab injections before an event was 2 (1-4). For eyes with an adverse event and visual acuity (VA) data (n = 406), median (IQR) change in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters from pre-event VA was 0 (- 7 to + 5) at the 6-month follow-up; 50 eyes (12.3%) had a VA loss of 10 or more ETDRS letters. Risk of an event (hazard ratio [95% confidence interval]) was decreased in eyes from male patients (0.61 [0.53-0.71]), from older patients (0.83 [0.76-0.90]), from treatment-naive patients (0.51 [0.38-0.69]), and from patients who started brolucizumab in the second year after launch (0.68 [0.53-0.86] vs. first year).

CONCLUSION

In this large real-world brolucizumab safety study, 3.4% of eyes experienced an IOI, RV, and/or RO event. Among eyes that experienced an adverse event for which VA data were available, median ETDRS vision change was 0 letters (IQR - 7 to + 5).

Fellow Eyes Conversion Rates in Patients With Unilateral Exudative Age-Related Macular Degeneration: An Academy IRIS® Registry Analysis

BACKGROUND AND OBJECTIVE

This study aimed to examine conversion rates from non-exudative to exudative age-related macular degeneration (AMD) in the fellow eye of patients with unilateral exudative AMD using the Academy IRIS® Registry.

PATIENTS AND METHODS

This study was a retrospective, cohort analysis from 2016 to 2019. Patient and disease characteristics including initial AMD stage were collected. Cox proportional-hazard (PH) and logistic regression modeling were performed.

RESULTS

The risk of conversion was lower for men relative to women and for Asians and Blacks relative to Whites. Compared to never-smokers, active smokers were at increased risk of conversion, and compared to initially early non-exudative AMD eyes, intermediate and advanced non-exudative AMD eyes had higher rates of conversion. Compared to active choroidal neovascularization eyes, eyes with inactive choroidal neovascularization and inactive scars had lower rates of fellow eye conversion.

CONCLUSIONS

In this cohort analysis of unilateral exudative AMD patients, women, Whites, and active smokers had higher rates of non-exudative to exudative AMD conversion in the fellow eye. [Ophthalmic Surg Lasers Imaging Retina 2024;55:220-226.].

Impact of Anti-VEGF Treatment and Patient Characteristics on Vision Outcomes in Neovascular Age-related Macular Degeneration: Up to 6-Year Analysis of the AAO IRIS® Registry

Purpose

To evaluate anti-VEGF treatment patterns and the influence of patient demographic and clinical characteristics on up to 6-year vision outcomes in neovascular age-related macular degeneration.

Design

Retrospective, multicenter, noninterventional registry study with up to 6 years of follow-up.

Participants

A cohort of 254 655 eyes (226 767 patients) with first anti-VEGF injection and at least 2 years of follow-up; 160 423 eyes had visual acuity (VA) data.

Methods

Anonymized patient data were collected in the United States through the IRIS® Registry (Intelligent Research in Sight).

Main Outcome Measures

Changes in VA from baseline; frequency of and gaps between intravitreal anti-VEGF injections; treatment discontinuations; switching anti-VEGF agents; and influence of baseline clinical and demographic characteristics on VA.

Results

After a mean VA increase of 3.0 ETDRS letters at year 1, annual decreases led to a net loss from baseline of 4.6 letters after 6 years. Patients with longer follow-ups had better baseline and follow-up VA. From a mean of 7.2 in year 1 and 5.6 in year 2, mean injections plateaued between 4.2 to 4.6 in years 3 through 6. Treatment was discontinued in 38.8% of eyes and switched in 32.3%. When adjusting for differences at baseline, every additional injection resulted in a 0.68 letter improvement from baseline to year 1; thus, multiple injections in a year have the potential to be clinically meaningful. Older age, male gender, Medicaid insurance, and not being treated by a retina specialist were associated with a higher likelihood of vision loss at year 1. Of the patients, 58.5% lost ≥ 10 letters VA at least once during follow-up, with 14.5% of patients experiencing sustained poor vision after a median of 3.4 years.

Conclusions

After modest mean VA improvement with intravitreal anti-VEGF injections at year 1, patients netted a loss of VA by year 6. Injection frequency decreased over time, and this was paired with a relatively high rate of discontinuation. Modeling suggested that more frequent injections were associated with better VA. Difficulty with continuous adherence to frequent intravitreal injections may have contributed to undertreatment resulting in less-than-optimal vision outcomes.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

[Frequency and distribution of the active agent of intravitreal injections in German centers 2015-2021-An oregis study]

INTRODUCTION

Digitalization in medicine, especially the electronic documentation of patient data, is revolutionizing healthcare systems worldwide. The evaluation of real-world data collected under everyday conditions presents opportunities but also challenges. Electronic medical registries provide a means to compile extensive patient data for scientific inquiries. Oregis is the first nationwide digital registry for health services research established by the German Ophthalmological Society (DOG). Intravitreal operative medicinal injections (IVOM) are among the most frequently performed procedures in ophthalmology. Data on injection numbers and injection frequencies with anti-vascular endothelial growth factor (VEGF) are already available from other countries, whereas data at a national level are not yet available in Germany due to the lack of a nationwide register. It is known that the treatment success of anti-VEGF IVOMs depends largely on the adherence to treatment and thus on the number of injections. There are also differences in cost. In the context of this study, real-world data on the frequency and distribution of intravitreal injections in German centers from 2015 to 2021 were compiled for the first time since the introduction of oregis. The aim of this study is to collect data on the use of anti-VEGF IVOMs in Germany from oregis for the first time and to show the development of injection numbers and anti-VEGF drugs used. At the same time, the possibilities of data retrieval from oregis are demonstrated using a concrete example from daily ophthalmological practice.

MATERIAL AND METHODS

An automated query of records was performed for all patients who received IVOM at oregis-affiliated healthcare facilities between 2015 and 2021. The number of treated patients and the use of anti-VEGF medications, including aflibercept, bevacizumab, brolucizumab, and ranibizumab, were determined. The data were collected in a pseudonymized and anonymized manner.

RESULTS

At the time of data collection, 9 German ophthalmological healthcare facilities were affiliated with oregis. In total, 309,152 patients were registered during the observation period, with 8474 receiving IVOMs. Over the observation period, the number of participating centers, patients, and intravitreal injections increased. The proportional share of anti-VEGF agents among the total number of injections varied during the observation period.

DISCUSSION

Real-world data captured in oregis offer significant potential for enhancing healthcare provision. Oregis enables the depiction of ophthalmological care conditions in Germany and contributes to research and quality assurance. The ability to query the presented data exemplifies the multitude of inquiries through which oregis can contribute to the representation of ophthalmological care in Germany.

Lessons From The Glaucoma Foundation Think Tank 2023: A Patient-Centric Approach to Glaucoma

PRCIS

The main takeaways also included that BIG DATA repositories and AI are important combinatory tools to foster novel strategies to prevent and stabilize glaucoma and, in the future, recover vision loss from the disease.

PURPOSE

To summarize the main topics discussed during the 28th Annual Glaucoma Foundation Think Tank Meeting "A Patient-Centric Approach to Glaucoma" held in New York on June 9 and 10, 2023.

METHODS

The highlights of the sessions on BIG DATA, genetics, modifiable lifestyle risk factors, female sex hormones, and neuroprotection in the field of primary open angle glaucoma (POAG) were summarized.

RESULTS

The researchers discussed the importance of BIG DATA repositories available at national and international levels for POAG research, including the United Kingdom Biobank. Combining genotyped large cohorts worldwide, facilitated by artificial intelligence (AI) and machine-learning approaches, led to the milestone discovery of 312 genome-wide significant disease loci for POAG. While these loci could be combined into a polygenic risk score with clinical utility, Think Tank meeting participants also provided analytical epidemiological evidence that behavioral risk factors modify POAG polygenetic risk, citing specific examples related to caffeine and alcohol use. The impact of female sex hormones on POAG pathophysiology was discussed, as was neuroprotection and the potential use of AI to help mitigate specific challenges faced in clinical trials and speed approval of neuroprotective agents.

CONCLUSIONS

The experts agreed on the importance of genetics in defining individual POAG risk and highlighted the additional crucial role of lifestyle, gender, blood pressure, and vascular risk factors. The main takeaways also included that BIG DATA repositories and AI are important combinatory tools to foster novel strategies to prevent and stabilize glaucoma and, in the future, recover vision loss from the disease.

Tube Versus Trabeculectomy IRIS Registry Study: 1-Year Secondary Treatment Outcomes

PURPOSE

To describe 1-year secondary outcomes in the Tube Versus Trabeculectomy IRIS® (Intelligent Registry In Sight) Registry Study (TVTIRIS), and to compare to the TVT randomized controlled trial (TVTRCT).

DESIGN

TVTIRIS was a retrospective cohort study.

METHODS

The 2013-2017 IRIS Registry was used to identify eyes that received a tube shunt (tube) or trabeculectomy after a previous trabeculectomy and/or cataract surgery and had 1 year of follow-up. The TVTRCT compared a Baerveldt 350-mm2 glaucoma implant to trabeculectomy in similar eyes.

RESULTS

In the TVTIRIS cohort, the tube (n = 236, 56.3%) and trabeculectomy (n = 183, 43.7%) groups had similar and significant reductions in intraocular pressure (IOP) from baseline to 1 year. In the tube group, IOP (mean ± SD) decreased from 26.6 ± 6.5 mm Hg at baseline to 14.3 ± 4.8 mm Hg at 1 year. In the trabeculectomy group, IOP decreased from 25.3 ± 6.4 mm Hg at baseline to 13.5 ± 5.2 mm Hg at 1 year. The trabeculectomy groups from both studies had similar 1-year IOP reduction (P = .18), although the TVTRCT cohort used fewer medications at all time points (P < .01). There were more pronounced differences in the mean IOP and medications between the tube groups in the 2 studies, presumably due to the inclusion of valved tubes in TVTIRIS. More reoperations occurred in TVTIRIS.

CONCLUSIONS

The TVTIRIS tube and trabeculectomy groups had comparable 1-year IOP reduction, although trabeculectomy eyes used fewer glaucoma medications. The trabeculectomy group in TVTIRIS and TVTRCT had similar IOP and medication reduction at 1 year. Randomized controlled trials and electronic health record data both provide invaluable insight into surgical outcomes.

Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis

Objective

To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

Design

Retrospective cohort study.

Participants

Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017.

Methods

Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery.

Main Outcome Measures

Incidence and risk factors for RRD or RT within 1 year of cataract surgery.

Results

Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99-3.32; P < 0.001 and 1.79; 95% CI, 1.70-1.89; P < 0.001), and younger ages compared with patients aged > 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74-9.58; P < 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52-2.98; P < 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82-11.28; P < 0.001), hypermature cataract (1.61; 95% CI, 1.06-2.45; P = 0.03), complex cataract surgery (1.52; 95% CI, 1.4-1.66; P < 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15-1.34; P < 0.001), and high myopia (1.2; 95% CI, 1.14-1.27; P < 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39-46.49; P < 0.001).

Conclusion

In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged > 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Causes of Childhood Blindness in the United States Using the IRIS® Registry (Intelligent Research in Sight)

PURPOSE

To investigate causes of childhood blindness in the United States using the IRIS® Registry (Intelligent Research in Sight).

DESIGN

Cross-sectional study.

PARTICIPANTS

Patients ≤ 18 years of age with visual acuity (VA) 20/200 or worse in their better-seeing eye in the IRIS Registry during 2018.

METHODS

Causes of blindness were classified by anatomic site and specific diagnoses.

MAIN OUTCOME MEASURES

Percentages of causes of blindness.

RESULTS

Of 81 164 children with 2018 VA data in the IRIS Registry, 961 (1.18%) had VA 20/200 or worse in their better-seeing eye. Leading causes of blindness were retinopathy of prematurity (ROP) in 301 patients (31.3%), nystagmus in 78 patients (8.1%), and cataract in 64 patients (6.7%). The retina was the leading anatomic site (47.7%) followed by optic nerve (11.6%) and lens (10.0%). A total of 52.4% of patients had treatable causes of blindness.

CONCLUSIONS

This analysis offers a unique cross-sectional view of childhood blindness in the United States using a clinical data registry. More than one-half of blind patients had a treatable cause of blindness.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

[oregis-The German ophthalmological registry]

BACKGROUND

Medical registries have shown their potential for medical research in different areas of healthcare in the past. The United States of America uses the well-known national ophthalmology registry Intelligent Research in Sight (IRIS®), on the basis of which insights into the ophthalmological care situation in the USA can be gained. Comparable projects do not currently exist in Germany. The oregis is the first disease-independent registry to collect comprehensive data in the field of ophthalmology in Germany for the purpose of healthcare research.

METHODS

The oregis collects anonymized clinical patient information from all subfields of ophthalmology and makes it available for research purposes. Participating centers read their data into the registry free of charge and preferably in an automated fashion. Currently, the oregis parameter list contains about 600 parameters, of which about 100 are used in the current pilot phase.

RESULTS

Since its initiation, the German ophthalmological registry oregis has compiled data on more than 1.75 million physician visits for more than 400,000 patients from German ophthalmologic centers. As of late 2022, more than 2.8 million visual acuity measurements and an equal number of intraocular pressure measurements have been recorded.

DISCUSSION

The aim of the oregis project is to establish a nationwide ophthalmology databank that forms the basis for a learning healthcare system in the field of ophthalmology. With the help of continuous updating, oregis can also illustrate short-term innovations in ophthalmological care.

Prevalence of and Associated Factors for Eyelid Cancer in the American Academy of Ophthalmology Intelligent Research in Sight Registry

PURPOSE

To estimate the prevalence of eyelid cancers in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry and evaluate the associated factors.

DESIGN

Retrospective IRIS Registry database study.

PARTICIPANTS

All patients in the IRIS Registry between December 1, 2010, and December 1, 2018, with International Classification of Disease, ninth and 10th revisions, codes for eyelid cancers (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], malignant melanoma [MM], sebaceous carcinoma/other specified malignant neoplasm [SBC], melanoma in situ [MIS], and unspecified malignant neoplasm [UMN]).

METHODS

The prevalence of each eyelid cancer type was estimated overall and by age group, sex, race, ethnicity, and smoking status. The associations between any eyelid cancer (AEC) or each cancer type and possible risk factors were examined using univariate and multivariate logistic regression models.

MAIN OUTCOME MEASURES

Prevalence of and associated factors for each eyelid cancer type.

RESULTS

There were 82 136 patients with eyelid cancer identified. The prevalence of AEC was 145.1 per 100 000 population. The cancer-specific prevalence ranged from 87.9 (BCC) to 25.6 (UMN), 11.1 (SCC), 5.0 (SBC), 4.1 (MM), and 0.4 (MIS) per 100 000 population. The prevalence of AEC and each cancer type increased with increasing age (all P < 0.0001), and the prevalence of AEC, BCC, SCC, and MM was higher in males (all P < 0.0001), MIS (P = 0.02). The prevalence of BCC, SCC, MM, SBC, and AEC was highest in Whites versus that in patients of any other race (all P < 0.0001). In the multivariate logistic regression model with associated risk factors (age, sex, race, ethnicity, and smoking status), AEC was associated with older age groups ([< 20 years reference {ref.}]; odds ratio [95% confidence interval]: 20-39 years: 3.35 [1.96-5.72]; 40-65 years: 24.21 [14.80-39.59]; and > 65 years: 42.78 [26.18-69.90]), male sex (female [ref.]; 1.40 [1.33-1.48]), White race (inverse associations with African Americans [0.12 {0.09-0.16}], Asians [0.19 {0.13-0.26}], others [0.59 {0.40-0.89}]), and ethnicity (non-Hispanic [ref.]; Hispanic: 0.38 [0.33-0.45]; unknown: 0.81 [0.75-0.88]). Active smoking (never smoker [ref.]) was associated with AEC (1.11 [1.01-1.21]), BCC (1.27 [1.23-1.31]), SCC (1.59 [1.46-1.73]), and MM (1.26 [1.08-1.46]).

CONCLUSIONS

This study reports the overall and cancer-specific prevalence of eyelid cancers using a large national clinical eye disease database. Smoking was found to be associated with AEC, BCC, SCC, and MM, which is a new observation. This epidemiologic profile of on-eyelid cancers is valuable for identifying patients at a higher risk of malignancy, allocating medical resources, and improving cancer care.

Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the Intelligent Research in Sight (IRIS®) Registry

Purpose

To identify clinical factors associated with the need for future surgical intervention following closed globe ocular trauma.

Design

Retrospective cohort study.

Subjects Participants and/or Controls

Patients in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry with a diagnosis of closed globe ocular trauma occurring between 2013 and 2019, identified using International Classification of Disease, 10th Revision and Systematized Nomenclature of Medicine codes.

Methods

Diagnosis codes were used to identify multiple concomitant diagnoses present on the date of closed globe ocular trauma. Survival analyses were performed for each outcome of interest, and linear regression was used to identify clinical factors associated with the risk of surgical intervention.

Main Outcome Measures

Outcomes included retinal break treatment, retinal detachment (RD) repair, retinal break treatment or RD repair, glaucoma surgery, and cataract surgery.

Results

Of the 206 807 patients with closed globe ocular trauma, 9648 underwent surgical intervention during the follow-up period (mean, 444 days): 1697 (0.8%) had RD repair, 1658 (0.8%) had retinal break treatment, 600 (0.3%) had glaucoma surgery, and 5693 (2.8%) had cataract surgery. Traumatic cataract was the strongest risk factor for cataract surgery (hazard ratio, 13.0; 95% confidence interval, 10.8-15.6), traumatic hyphema showed highest risk for glaucoma surgery (7.24; 4.60-11.4), and vitreous hemorrhage was the strongest risk factor for retinal break treatment and detachment repair (11.01; 9.18-13.2 and 14.2; 11.5-17.6, respectively) during the first 60 days after trauma date. Vitreous hemorrhage was a risk factor for cataract surgery at > 60 days after trauma date only. Iris-angle injury was the strongest risk factor for glaucoma surgery > 60 days after trauma, while vitreous hemorrhage remained the strongest factor for retinal break treatment and detachment repair at > 60 days. Traumatic hyphema was a risk factor for all surgical outcomes during all follow-up intervals.

Conclusions

Diagnosis of concomitant traumatic cataract, vitreous hemorrhage, traumatic hyphema, and other risk factors may increase the likelihood of requiring surgical intervention after closed globe ocular trauma.

The evolving field of Big Data: understanding geographic information systems analysis and its transformative potential in ophthalmic research

PURPOSE OF REVIEW

The purpose of this review to is to highlight alternative uses of Big Data in the pursuit of ophthalmologic public health. In particular, we highlight geographic information systems (GIS) analysis as a type of Big Data, summarize various GIS methods, and enumerate sources of geographic data.

RECENT FINDINGS

The recent implementation of the IRIS Registry Data, has expanded our real-world knowledge of ophthalmology in the United States. Such innovations in Big Data allow us to better define ophthalmic diseases, treatments, and outcomes for underserved individuals and subpopulations. One underutilized source of Big Data entails use of geographic information to evaluate geographic heterogeneity and access across the United States.

SUMMARY

GIS and Big Data allow for refined epidemiologic estimates of eye disease for specific communities. In particular, how GIS can enable researchers to examine disparities in access to ophthalmic care is reviewed. GIS best practices and some data sources for GIS in ophthalmology are also summarized.