Factors Associated with Visual Outcome after Primary Repair of Open-Globe Injury by Ophthalmology Residents in Training in a Tertiary Eye Center

Open-Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014 - 2018: Incidence, Risk Factors, and Visual Outcomes

PURPOSE

To estimate incidence and evaluate demographic risk factors and visual acuity (VA) outcomes of open-globe injuries requiring surgical repair in the IRIS® Registry (Intelligent Research in Sight).

DESIGN

Retrospective cohort study.

PARTICIPANTS

Patients with open-globe injury repairs (OGRs) were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, and 65265) from 2014 through 2018 in the IRIS Registry.

METHODS

Logistic regression models adjusting for age, sex, race, ethnicity, United States region, concurrent and subsequent surgeries, and baseline VA.

MAIN OUTCOME MEASURES

Outcomes included annual and 5-year incidence rates per 100 000 people and factors associated with OGR, VA better than 20/40, and VA of 20/200 or worse at final follow-up (3-12 months after OGR).

RESULTS

Thirteen thousand seven hundred sixty-six OGRs were identified; 5-year cumulative incidence was 28.0 per 100 000 patients. Open-globe repair was associated with age 21 to 40 years compared with younger than 21 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.5-1.7]), male sex (OR, 2.8; 95% CI, 2.7-2.9), Black versus White race (OR, 1.3; 95% CI, 1.2-1.4), Hispanic versus non-Hispanic ethnicity (OR, 1.7; 95% CI, 1.6-1.8), and South (OR, 1.4; 95% CI, 1.3-1.5) and West (OR, 1.3; 95% CI, 1.2-1.4) versus Midwest regions and associated inversely with Asian versus White race (OR, 0.6; 95% CI, 0.6-0.7). Visual acuity outcomes, analyzed in a subset of 2966 patients with VA data available, showed vision impairment (VA < 20/40) at final follow-up was associated with VA of 20/200 or worse at presentation (20/200 better than 20/40; OR, 11.1; 95% CI, 8.0-15.7), older age (e.g., > 80 years vs. < 21 years; OR, 5.8; 95% CI, 3.2-10.7), and Black versus White race (OR, 1.8; 95% CI, 1.3-2.6). Risk factors were similar for VA of 20/200 or worse after OGR. Among the 1063 patients undergoing OGR with VA of 20/200 or worse at presentation, VA did not improve to better than 20/200 at follow-up in 35% of patients (1063/2996).

CONCLUSIONS

Our findings bring to light racial disparities in risk of OGR and poor visual outcomes that warrant further exploration.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Reliability of open globe injury repair surgical videos on the internet for resident education

Introduction

This study aimed to assess quality of surgical training videos for management of open globe injury (OGI) on online platforms.

Material and Methods

Twenty-three websites with surgical training videos were queried using the search keyword “open globe repair.” Video content characteristics and quality assessment scores using Sandvik score, Health on the Net Foundation Code of Conduct (HON code), mDISCERN scoring, and global quality score (GQS) were recorded. To evaluate the relevance of the surgical videos to the surgical procedure, steps were analyzed as per the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management.

Results

One hundred and twenty-three videos were evaluated, and 63 analyzed. Majority videos were uploaded by solitary ophthalmologists (53/63; 84.13%). Mean video quality score (VQS) and GIS scores were 6.55 ± 1.59 and 7.95 ± 1.39, respectively. Mean mDISCERN, GQS, HON Code and Sandvik scores for all the videos were 2.87 ± 1.07, 3.77 ± 1.08, 5.14 ± 1.67, 12.06 ± 1.84, respectively. Videos with background audio and descriptive subtitles had significantly better quality ( p < 0.05). All Quality assessment scores showed a statistically significant ( p < 0.000) positive correlation with each other. On linear regression analysis, number of video likes, comments and views had a significant ( p < 0.05) positive relation with quality of video, whereas video length showed a negative relation with different scores.

Conclusion

Nearly two-thirds of surgical videos showing OGI repair had good quality assessment scores. Consensus guidelines should be developed to guide uploaders as regards the essential features required for good quality surgical videos using a standardized rubric.