Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ARVO 2014 Annual Meeting Abstracts 507 Health care delivery around the world Thursday, May 08, 2014 8:30 AM–10:15 AM Exhibit/Poster Hall SA Poster Session Program #/Board # Range: 5547–5596/A0156–A0205 Organizing Section: Clinical/Epidemiologic Research Contributing Section(s): Retina Program Number: 5547 Poster Board Number: A0156 Presentation Time: 8:30 AM–10:15 AM Reporting of Harms by Randomized Controlled Trials in Ophthalmology Roderick O’Day1, 3, Richard Walton3, Richard Blennerhassett2, Mark C. Gillies3, Daniel Barthelmes3, 4. 1Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; 2Westmead Hospital, Sydney, NSW, Australia; 3Save Sight Institute, University of Sydney, Sydney, NSW, Australia; 4Ophthalmology, University Hospital Zurich, Zurich, Switzerland. Purpose: To evaluate the reporting of harms by randomized controlled trials investigating intravitreal therapies for diabetic macular edema. Methods: A thorough literature search identified eligible reports. Two authors independently extracted data from these using a prospectively created checklist. The main outcome measure was compliance with the 10 recommendations of the 2004 Consolidated Standards of Reporting Trials statement extension for better harms reporting. Secondary outcomes were the predictors of the number of recommendations met and the amount of space devoted to harms reporting. Results: Thirty-six articles involving 7246 eyes met the criteria for analysis. The fidelity of the data extraction was excellent, with Cohen’s kappa coefficient of 0.90 for all items extracted. The median number of recommendations met was 6, interquartile range 5 to 7. Recommendation four (describe how harms-related information was collected) was met by 97% of articles and recommendation eight (present the absolute risk of each adverse event) by 92%. The least frequently met recommendations were numbers three (list addressed adverse events with definitions of each), 31% of articles, and six (describe participant withdrawals because of harms), 36% of articles. The following article characteristics were associated with meeting more recommendations by univariate analyses: articles reporting trials that were placebo-controlled, involved a dose comparison, had more than the median sample size, were multi-centered and were commercially funded; and articles that were published in journals with an impact factor more than 3. However, none of these article characteristics were found to be associated with the number of recommendations met using a binomial regression analysis. The mean percentage of the results section devoted to harms-related data was 25.8%, standard deviation 10.8%. Conclusions: Harms reporting in published reports of trials of intravitreal therapies for diabetic macular edema is still not entirely adequate despite increased attention and efforts to standardise it. Commercial Relationships: Roderick O’Day, None; Richard Walton, None; Richard Blennerhassett, None; Mark C. Gillies, Allergan (C), Bayer (C), Novartis (C); Daniel Barthelmes, None Program Number: 5548 Poster Board Number: A0157 Presentation Time: 8:30 AM–10:15 AM Importance of Different Barriers to Glaucoma Medication Adherence Paula Anne Newman-Casey1, Taylor Blachley1, Karen B. Farris2, Alan L. Robin3, 4, Paul P. Lee1. 1Ophthalmology & Vis Sci, Kellogg Eye Center, University of Michigan, Ann Arbor, MI; 2College of Pharmacy, University of Michigan, Ann Arbor, MI; 3Ophthalmology, Johns Hopkins, Baltimore, MD; 4International Health, Johns Hopkins, Baltimore, MD. Purpose: Adherence to glaucoma medications is often poor and has many potential barriers. We identified 11 barriers to adherence that have been repeatedly cited in the literature. We hypothesized that each glaucoma patient would have a unique set of barriers to overcome to achieve optimal adherence. We administered a questionnaire to determine which barriers were most common. Methods: We surveyed a convenience sample of 185 glaucoma patients. Subjects rated 11 barriers’ importance on a 20-point response scale anchored with “very important” to “not important.” We measured patient reported adherence using a validated instrument, the Morisky Adherence Scale. We assessed sociodemographic characteristics. We conducted descriptive analyses and principal component analysis to identify the structure of the relationships among the adherence variables. Logistic regression was used to predict the association of the principal components with medication adherence. Results: Each of the eleven barriers was cited as significant by 30%52% of subjects, who had glaucoma for a mean of 11.5±10.8 years. 26.5% of subjects were non-adherent by self-report. The principal component analysis revealed two factors. The first factor included all of the barriers and had a 48% increased odds of non-adherence, OR=1.48 [95% CI 1.03-2.12, p=0.04], meaning that the more barriers a person reported, the more likely they were to be non-adherent. The second factor revealed that those who had good adherence reported that a poor doctor-patient relationship along with beliefs and knowledge about their disease and medications were important barriers to medication adherence, OR=0.50 [95% CI 0.32-0.80, p = 0.004]. Those who were non-adherent reported that difficulties with their medication schedule, forgetfulness, a lack of confidence, too much other stress, medication side effects, cost and lack of ability to instill the drops were important barriers to taking their medications. Conclusions: No single barrier to adherence emerged as most important to all glaucoma patients, though barriers did differ for those patients who were and were not adherent. Since poor adherence is associated with disease progression, it is imperative to develop individualized interventions to help glaucoma patients improve their self-management. Commercial Relationships: Paula Anne Newman-Casey, None; Taylor Blachley, None; Karen B. Farris, None; Alan L. Robin, Aerie (C), Biolight (C), Glaukos (C), Ioptima (C), Merck (C); Paul P. Lee, GlaxoSmithKline (I), Merck (I), Pfizer (I) Support: National Eye Institute Michigan Vision ClinicianScientist Development Program (K12EY022299); Heed Foundation Fellowship ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5549 Poster Board Number: A0158 Presentation Time: 8:30 AM–10:15 AM Evaluation of two metrics for identifying poor glaucoma medication adherence compared to objective adherence measurements Jaya Badhwar1, 4, Hayden Bosworth2, 4, Betsy Sleath3, Susanne Danus4, Logan Christensen1, Kelly W. Muir1, 4. 1Department of Ophthalmology, Duke University, Durham, NC; 2Department of Medicine, Duke University, Durham, NC; 3School of Pharmacy, University of North Carolina, Chapel Hill, NC; 4Health Services Research and Development, Durham VA Medical Center, Durham, NC. Purpose: Poor adherence to the prescribed glaucoma medication regimen may lead to preventable blindness. Previous work suggests that providers may not accurately identify nonadherent patients. The purpose of this project was to compare 2 screening methods for identifying nonadherence on the criteria of feasibility and correlation with objective adherence measurements from an electronic monitor. Methods: Patients from 2 eye clinics (a university practice and a VA hospital) with medically-treated glaucoma were given a survey of medication adherence including the question “how many times did you miss your drops in the last week” and a visual analog scale (VAS) on which patients mark on a line how much of the time they take their drops as prescribed. Participants received electronic monitors to record when the medication was accessed until the next clinic visit. The 2 measures were evaluated for feasibility (how many participants responded), sensitivity and specificity for detecting nonadherence. Results: Adherence was defined as the proportion of prescribed doses taken according to the monitor. Of 142 participants, 132 returned the monitors, average duration of use 179 days (SD 69, median=179). Mean percent of the prescribed doses taken was 83.3 (SD 23, median 94). For the question, “how many times did you miss your drops last week?”, 23 failed to answer; 100 responded that they had not missed any drops in the last week. 2 failed to complete VAS, 124 responding with <100% adherence. In regards to detecting adherence of <80%, a VAS score <1 was 90% sensitive and 13% specific. A response of >1 on the item “how many times did you miss your drops in the past week” was 26% sensitive and 88% specific for detecting nonadherence. Conclusions: More participants responded to the VAS than to the question regarding missed drops. Possible explanations include that the VAS is easier to interpret or is associated with less perceived stigma than admitting to a specific number of missed doses. The VAS was more sensitive at detecting poor adherence than the question regarding missed drops, but less specific. The low specificity of the VAS suggests that although the tool may be a useful screener for nonadherence, clinicians must delve more deeply if the screen is positive to determine the nature of the patient’s difficulty with the prescribed regimen. Commercial Relationships: Jaya Badhwar, None; Hayden Bosworth, None; Betsy Sleath, None; Susanne Danus, None; Logan Christensen, None; Kelly W. Muir, None Support: VA Health Services Research & Development Career Development Award 10-019-2, American Glaucoma Society Clinician Scientist Award Program Number: 5550 Poster Board Number: A0159 Presentation Time: 8:30 AM–10:15 AM Association between Anxiety and Depression with the Frequency of Eye Drops in Inflammatory Eye Disease Patients Georgios Vakros1, James Hodson2, Philip I. Murray1, Saaeha Rauz1. 1Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, United Kingdom; 2Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, United Kingdom. Purpose: Patients with chronic inflammatory eye disease (IED) often require lifelong treatment including the use of frequently applied topical therapy. Therapeutic regimens are arduous and maintaining adherence can impact upon daily activities and general wellbeing. We wished to assess anxiety, depression and quality of life in patients with IED and if there is an association with the administration of topical medication. Methods: 200 consecutive patients with IED - Ocular Surface Disease (OSD, 100) and Uveitis (100) - completed a selfadministered questionnaire that comprised a patient reported measure of ocular symptoms (Ocular Surface Disease Index (OSDI)) and validated wellbeing questionnaires (Hospital Anxiety and Depression (HAD), World Health Organisation Quality of Life-BREF (WHO QOL-BREF)), together with supplemental questions on the frequency of eye drops and the use of systemic glucocorticoids. Descriptive and non-parametric tests were used to analyse the impact of topical medication on depression, anxiety and quality of life scores within the group as a whole and when stratified into the two clinical groups. Results: Patients (126(63%) female, 74(37%) male) with a mean (±SD) age 54±5 years (OSD, 56±1; uveitis, 51±1; p=0.032) from a variety of ethnic backgrounds (White 132(66%), Black 8(18%), South Asian 45(23%) and Other 5(3%)) reported moderate/severe ocular symptoms as measured by the OSDI. Forty patients (20%) were found to be clinically depressed and 33(16.5%) had clinical anxiety. There was no difference between the two groups. The frequency of the eye drops had a direct impact on both anxiety and depression with a more pronounced effect in the OSD patients (p<0.001). The use of systemic glucocorticoids was also a significant factor linked to anxiety and depression (p=0.005). In patients who demonstrated anxiety or depression, quality of life was reduced in all four domains measured (physical, psychological, social relationships, environmental (p<0.001)). Conclusions: The use of frequent topical medications impacts upon and positively correlates with the psychological status of IED patients with 1:5 developing anxiety and depression. These patients also demonstrate a poorer quality of life. This highlights the need for counselling in the IED clinic either through a clinical psychologist or eye clinic liaison officer. Commercial Relationships: Georgios Vakros, None; James Hodson, None; Philip I. Murray, None; Saaeha Rauz, None Program Number: 5551 Poster Board Number: A0160 Presentation Time: 8:30 AM–10:15 AM Real-World Analysis of the Time Associated with Adding a Second Glaucoma Therapy in Newly Diagnosed OAG/OHT Patients William Wong1, Ashley L. Cole2, Jenny Chia2. 1GHOSR, Allergan, Irvine, CA; 2CHDA, Allergan, Irvine, CA. Purpose: Determine the time associated with moving from monotherapy (1 glaucoma drug class) to adding a 2nd glaucoma drug class in newly diagnosed patients. Methods: Patients with at least 2 diagnoses at least 1 week apart of ocular hypertension or open-angle glaucoma between 20092011, initiated on monotherapy, with at least 12 months continuous ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts enrollment before and after initial diagnosis were identified from a longitudinal database (MarketScan®) of medical and pharmacy claims for >43 million patients. Newly diagnosed patients were identified as those having no glaucoma drug, procedure or diagnosis 1 year prior to the index diagnosis. Kaplan-Meier survival analyses were used to assess the time to failure, defined as prescription drug fills for 2 different glaucoma drug classes ≤15 days apart. Drug classes were defined as follows: Prostaglandin analog or prostamide (PGA), beta blocker (BB), carbonic anhydrase inhibitor (CAI) and alpha agonist (AA). Patients were followed until addition of a 2nd drug class or the end of enrollment (max of 4 years). Results: Among newly diagnosed patients, 53% did not fill a prescription for a glaucoma drug within 1 year of initial diagnosis, leaving in total, 34,165 patients included in the base case analysis. By 4 years, 27.5% of at risk patients added a 2nd drug class. This proportion differed by initial therapy (PGA: 26.5%, BB: 29.5%, AA: 32.1%, CAI: 48.0%, p<0.0001 for log-rank test). Among those patients adding a 2nd drug class, 50% added a 2nd class by 8.7 months (mean of 11.7 months). The mean and median time to adding a 2nd drug class also differed by the initial therapy (Drug class: mean/median (months), PGA: 11.8/9.5, BB: 11.1/8.7, AA: 8.6/6.5, CAI: 6.8/3.2). PGAs and fixed combination products were most commonly used in multiple medication regimens. Conclusions: Clinical studies have shown a benefit for early treatment however in this analysis >50% of patients were not receiving medications within a year of diagnosis, suggesting many may be at increased risk of disease progression. This study also suggests that in the real-world, patients may be receiving fewer medications than required to control intraocular pressure as demonstrated in clinical trials. Of those patients who add a 2nd drug class, a majority require the additional therapy within 1 year emphasizing the importance of choosing the most effective initial treatment regimen. Commercial Relationships: William Wong, Allergan (E); Ashley L. Cole, Allergan (E); Jenny Chia, Allergan (E) Program Number: 5552 Poster Board Number: A0161 Presentation Time: 8:30 AM–10:15 AM Use of eye care services among US adults Asel Ryskulova, Rebecca Hines. NCHS, CDC, Hyattsville, MD. Purpose: To provide national self-reported data on use of eye care services and evaluate demographic and socio-economic disparities by analyzing the data from National Health Interview Survey (NHIS). Methods: Regular use of eye care services can help to diagnose eye diseases on their early treatable stages and prevent vision loss. The data from the 2012 NHIS, and 2002 and 2008 Vision Health supplement of NHIS, a nationally representative sample of the U.S. population were used. We included bivariate and multivariate analyses to determine dilated eye examination use, visit to eye care professional, and inability to buy eyeglasses in the past 12 months by selected socio-demographic covariates, health insurance, and diabetes status. Results: In 2008 55.0% of U.S. adults had dilated eye examination in the past 2 years. In 2012 37.1% of persons visited eye doctor or eye health professional in the past 12 months, and 7.7% of adults needed but could not afford to buy eyeglasses in the past 12 months. Women were more likely than men to receive eye exam, visit eye doctor, and could not afford to buy eye glasses. Hispanics, persons with less than high school education, and adults without health insurance were less likely to use eye care services. American Indians and Alaska Natives and black persons reported inability to buy eyeglasses more frequently compared with other race/ethnic groups. Age was a significant predictor of eye care services utilization: the rate of eye examination and visits to eye care providers for adults 65 year and older was almost twice of the rate for persons 18-24 years. Persons with diabetes were two times more likely to have dilated eye examination and report inability to buy eyeglasses than persons without diabetes history. Conclusions: The number of visits to eye doctors and inability to buy eyeglasses increased since 2002; however, there were no significant changes in use of dilated eye exam between 2002 and 2008. The national data demonstrate that use of eye care services varies by socio-demographic factors and diabetes status. Collaborative efforts of eye care providers and public health professionals are needed to increase use of regular eye services. Commercial Relationships: Asel Ryskulova, None; Rebecca Hines, None Program Number: 5553 Poster Board Number: A0162 Presentation Time: 8:30 AM–10:15 AM Ophthalmic Use of City Hospital Emergency Services Ilyse D. Haberman, Elisabeth J. Cohen, Anam Qureshi, Lisa Park. Ophthalmology, New York University, New York, NY. Purpose: To investigate demographics and characteristics of ophthalmology consults in a city hospital emergency department (ED) after the economic recession of 2008. Methods: A retrospective chart review was performed to assess the nature of ophthalmic use of a large city ED after the economic recession of 2008. Consults to a busy ophthalmology residency program were reviewed for 2007-2013. The first 10 consults from each month May-August were reviewed as a representative sample of consults received. These months were chosen as they bring in different numbers and types of consults as the new residency year begins (Fig. 1). Results from before and after the recession were statistically analyzed using a z-test for comparison of proportions. Results: From 2007-2013, a total of 4245 ED consults were done by the ophthalmology department (Fig. 2). After 2008, the population visiting the ED was predominantly Hispanic (30.8%), Black (25.8%), and white (24.1%). 47.0% had no insurance, 21.7% had Medicaid only, and 9.6% were in police custody. 62.1% of consults walked in, while 24.6% arrived to the ED by ambulance. About one third (33.75%) of the consults were status post blunt trauma; orbital wall fracture was the most common diagnosis (17.9% of consults). 17.1% were called for routine or chronic matters (i.e. dry eye, blepharitis, conjunctivitis, cataract). Only 10% of consults seen were patients previously known to the outpatient clinic. Of the consults, 84.2% were advised to follow up in our outpatient clinic; 67.3% of these patients were lost to follow up before 3 months or completion of treatment. There was no significant difference in these percentages when compared to data from 2007. Conclusions: A third of urgently called consults are post-trauma, but a large proportion of consults are called on routine ophthalmic problems. Consults appear unchanged since the recession. Knowledge of the epidemiology and follow-up patterns of consults seen in a city hospital ED can aide in triage, treatment, and patient counseling to encourage follow-up. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Figure 1: May/June and July/August were chosen as representative months as we tend to see different numbers and types of consults in those months as the seasons and experience of ED residents evolve Figure 2: Total ED consults called to ophthalmology per year. * Of note, the ED was closed secondary to Hurricane Sandy from Nov and Dec 2012. **Numbers up until Sept 2013 (further data will be added until the end of 2013). Commercial Relationships: Ilyse D. Haberman, None; Elisabeth J. Cohen, None; Anam Qureshi, None; Lisa Park, None Program Number: 5554 Poster Board Number: A0163 Presentation Time: 8:30 AM–10:15 AM Characteristics of Inpatient Ophthalmology Consults Associated with Ocular Pathology and Need for Ophthalmologic Intervention Jason Mayer1, Zachary Landis1, Ming Wang2, Ingrid U. Scott1. 1 Ophthalmology, Penn State Hershey Eye Center, Hershey, PA; 2 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA. Purpose: To identify, among inpatient ophthalmology consults, clinical examination findings predictive of ocular pathology and need for ophthalmologic intervention Methods: The medical records of patients evaluated by the ophthalmology consultation service at Penn State Hershey Medical Center between 9/1/2012 and 8/31/2013 were reviewed. Consults for retinopathy of prematurity and non-accidental trauma were excluded. Data collected include demographic characteristics, reason for consult, ophthalmology exam findings, primary/ secondary ophthalmic diagnoses, procedure/intervention performed as a result of the consult, length of hospitalization prior to consult, and duration of hospitalization. Data were analyzed to investigate associations between exam findings (specifically visual acuity, pupil and extraocular muscle [EOM] exam) and the presence of ocular pathology and need for intervention. Results: To date, data have been collected from 173 patients. The study population includes 96 (55.5%) men and the mean patient age is 40 years. Decreased vision (30.0%) was the most common reason for consultation followed by “rule out ocular/orbital trauma” (24.3%) and eye pain (8.7%). Services requesting the most consults were trauma (17.9%), pediatrics (15.0%) and medicine (13.3%). The most common primary ophthalmic diagnoses were orbital fracture (15.6%), normal ocular exam (12.1%) and fungal endophthalmitis ruled out (7.5%). Forty-three percent of consults resulted in no intervention, while the most common interventions were outpatient follow-up (23.1%), medication (20.8%) and further imaging (8.1%). Abnormalities on pupil exam and decreased visual acuity (defined as 20/40 or worse as measured with a near card) were significant predictors of the need for intervention (p=0.005 and p=0.03, respectively). Abnormal EOM exam was not a significant predictor of the need for intervention (p=0.47). Conclusions: Ophthalmological inpatient consultation makes a significant difference in the care of hospitalized patients, with over half of ophthalmology consults resulting in interventions such as medications, further imaging/labwork, or surgery. For busy inpatient consult services, visual acuity and pupil exam findings communicated to the ophthalmology service by the primary team can help triage how likely a patient is to need intervention and how urgently a patient needs to be evaluated. Commercial Relationships: Jason Mayer, None; Zachary Landis, None; Ming Wang, None; Ingrid U. Scott, None Program Number: 5555 Poster Board Number: A0164 Presentation Time: 8:30 AM–10:15 AM The Scope of an Inpatient Ophthalmology Consult Service Before and After Hurricane Sandy Anam Qureshi, Elisabeth J. Cohen, Ilyse D. Haberman, Lisa Park. Ophthalmology, New York University, New York, NY. Purpose: To profile patient demographics, volume, and eye disease seen by the Inpatient Ophthalmology Consult Service of a large public hospital before and after Hurricane Sandy Methods: A total of 1,269 consults were seen from 11/1/2011 to 11/30/2013, including the time of closure of the Inpatient Consult Service from 10/31/2012 to 2/9/2013 following Hurricane Sandy. We reviewed inpatient medical records, discharge summaries, and Ophthalmology Consultation Service notes of the first 10 new consults each month for a total of 220 patients. Results: 708 consults with an average of 59 consults per month were seen prior to Hurricane Sandy. 561 consults with an average of 56.1 consults per month were seen after Hurricane Sandy. Of 220 consultation requests reviewed, the mean age was 45.6 years with predominance of male (155, 70.5%) over female (65, 29%) patients. The most common reason for inpatient consultation prehurricane and post-hurricane was as follows: decreased vision (18 (15%) and 26 (26%)), eye trauma (28 (23%) and 15 (15%)), rule out systemic disease involvement (12 (10%) and 13 (13%)), and eye pain (10 (8%) and (8) 8%). The most common primary diagnosis was normal exam or refractive error (41 (34%) and 28 (28%)), orbital fracture (18 (15%) and 6 (6%)), blepharitis or dry eye syndrome (11 (9%) and 9 (9%)), and diabetic retinopathy (3 (2%) and 6 (6%)). Of the total consultations seen, 84 (70%) pre-hurricane and 63 (63%) post-hurricane patients were recommended follow up in the ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Ophthalmology Clinic, and 25 (20%) pre-hurricane and 13 (13%) post-hurricane patients actually followed up. Pre-hurricane insurance status was similar to post-hurricane insurance status: uninsured (53 (44%) and 50 (50%)), Medicaid (38 (32%) and 25 (25%)), other insurance type (14 (12%) and 16 (16%)), and Prison Health Service or Police Custody (13 (11%) and 8 (8%)). For 43 (36%) patients before and 49 (49%) patients after the hurricane, the current inpatient admission was their first admission to Bellevue Hospital. *Note: Results through 2/9/2014 (one year after reopening of the Inpatient Consult Service) will be presented. Conclusions: This study profiled common diagnosis, follow up rates, volume, and demographics of patients at a large public hospital affected by a major natural disaster. Despite closure for greater than three months, the inpatient consult service recovered without much change in these outcome measures. Commercial Relationships: Anam Qureshi, None; Elisabeth J. Cohen, None; Ilyse D. Haberman, None; Lisa Park, None Program Number: 5556 Poster Board Number: A0165 Presentation Time: 8:30 AM–10:15 AM Surgical outreach eye programs: a comparison of communitybased vs. hospital-based cataract surgery delivery Sushant Wagley1, Emily Cole2, Badri Badhu3, Manoj Sharma4. 1 College of Human Medicine, Michigan State University, East Lansing, MI; 2Tufts University School of Medicine, Boston, MA; 3 Ophthalmology, BP Koirala Institute of Health Sciences, Dharan, Nepal; 4Ophthalmology, Royal Australasian College of Surgeons, Dili, Timor-Leste. Purpose: To compare systems indicators and delivery methods for community-based vs. hospital-based surgical outreach eye programs conducted by various eye care institutions in Nepal over a year. Methods: Programmatic data from 18 community-based and 8 hospital-based eye camps conducted through various eye care institutions in Nepal were analyzed for systems and delivery indicators including: the total number and type of camps, number and type of healthcare provider present at each camp, total number of patients screened, total number of surgeries performed, number and type of cataract surgeries/non-cataract procedures performed, and post operative follow-up protocol utilized by each institution. Results: From the 26 eye camps included in this sample, 16784 patients were screened for eye pathologies and 2330 received cataract removal - with a majority (98.39%) getting PC-IOL implantation. There was no significant difference in the number of males and females treated at these camps. The total number of ophthalmologists at the various eye care institutions ranged from 2 to 25, however, usually only one ophthalmologist was present at each eye camp. Average team size was 10 at community-based surgical camp vs. 8 at hospital-based surgical camps. Average follow up ranged from 1 to 30 days post-operative care, with 65.3% of the programs conducting only one-day post-operative follow-up care. Conclusions: Eye care institutions in Nepal organized more hospital-based surgical outreach eye programs than community-based surgical camps per year. Both types of camps effectively screened and operated on a large numbers of patients. Clinical protocols and systems delivery protocols utilized to carry out the hospital-based vs. community-based eye camps did not differ between institutions. Further studies analyzing financial data and resource utilization for surgical outreach eye programs are necessary to increase cataract surgery coverage in resource limited settings throughout the world. Commercial Relationships: Sushant Wagley, None; Emily Cole, None; Badri Badhu, None; Manoj Sharma, None Program Number: 5557 Poster Board Number: A0166 Presentation Time: 8:30 AM–10:15 AM Detection of Non-Glaucomatous Ocular Pathology and Barriers to Follow-Up in a Community Glaucoma Detection Program Wanda D. Hu1, Cindy X. Hu1, Judie Tran1, Edward Pequignot2, Michael Waisbourd1, Lisa A. Hark1, L Jay Katz1. 1Glaucoma, Wills Eye Hospital, Philadelphia, PA; 2Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, CA. Purpose: To evaluate the detection rates of non-glaucomatous ocular pathology requiring follow-up care and to identify the barriers to this follow-up care in a Centers for Disease Control and Prevention (CDC)-sponsored community glaucoma detection program. Methods: Subjects 18 or older participated in a CDC-sponsored community-based exam to detect glaucoma throughout Philadelphia, Pennsylvania. An ophthalmologist conducted a slit lamp examination, gonioscopy, and an undilated fundus exam. Octopus® perimetry and optic nerve head photography were also performed. Subjects who were recommended for follow-up ophthalmic care at their own eye care provider for non-glaucomatous ocular pathology were also recorded. These subjects were given a telephone survey to assess rates of follow-up and to evaluate potential barriers to follow-up. Survey results were correlated with attendance of a follow-up exam using the Wilcoxon nonparametric test and Fisher’s exact test. Results: Eight hundred and ninety-nine (899) subjects were examined from January 2013 to August 2013. One hundred three (103) subjects (11%) diagnosed with non-glaucomatous ocular pathology were recommended follow-up ophthalmic care for visually significant cataracts (6.9%), diabetic retinopathy (1.0%), macular degeneration (1.7%) and other ocular pathology (2.2%). Fifty-eight of the 103 subjects (56%) responded to the telephone survey. The average age of respondents was 58 years and females (64%) and African-Americans (69%) predominated. Of the respondents, 29% attended a follow-up appointment. Subjects who did not remember their results and recommendations were less likely to attend their follow-up appointment (p=0.036 and 0.039, respectively). Subjects’ primary language (p=0.73), education level (p=0.68), type of transportation (p=1.0), type of health insurance (p=0.18), and interval of time between their last visit to an eye specialist and the glaucoma exam (p=0.053) were not significantly associated with attending their follow-up appointment. Conclusions: A community-based glaucoma exam is able to detect a significant amount of non-glaucomatous ocular pathology requiring further ophthalmic follow-up. However, actual follow-up rates at participants’ own eye care provider are poor and warrant the need to continue follow-up eye care at these community sites. Commercial Relationships: Wanda D. Hu, None; Cindy X. Hu, None; Judie Tran, None; Edward Pequignot, None; Michael Waisbourd, None; Lisa A. Hark, None; L Jay Katz, Aerie Pharm (C), Aerie Pharm (F), Alcon (C), Allergan (C), Allergan (F), Bausch & Lomb (C), Bausch & Lomb (F), Glaukos (C), Glaukos (I), Inotek (C), Merck (F), Sensimed AG (C), Sucampo (C) Support: CDC grant number 1U58DP004060-02 Program Number: 5558 Poster Board Number: A0167 Presentation Time: 8:30 AM–10:15 AM Foundation and Applications of the Universal EYE Exam Translator Samir I. Sayegh. EYE Ctr Anterior- Vitreoretinal Surg, Eye Center/ The Retina Center, Champaign, IL. Purpose: To provide an accurate, practical and universal tool to interact with patients undergoing an eye examination, regardless of their spoken language. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Methods: A basic script for an interactive eye examination was developed based on experience in a variety of languages and eye examination contexts. The script and a translation template were assigned to a number of collaborators including ophthalmologists, physicians in other specialties, health care professionals, linguists and other professionals, who transferred it to their respective mother tongue. The template included four categories: language of origin, a translation, transliteration and audio. Specific attention was directed to the peculiarities of each language and translations to different dialects of the same language were included. A web interface to allow new contributions as well as access the tool has been designed. The site includes the list of all contributors to the project. Results: All continents and languages covering over 75% of the world’s population have been covered and a number of languages clinically tested with good success and facilitation of eye examination and communication with a diverse population of patients. Conclusions: We have developed a universal tool to develop and field a system of multilingual access to an eye examination. The applications to onsite examination for a diverse population, education of opthalmologists and other health professionals, telemedicine and computer assisted communication of a richer medical vocabulary have been demonstrated. The methods and results can be extended to other subspecialties as well as primary care medicine. This can be done in a highly efficient way based on web based access for contributors and users alike. Commercial Relationships: Samir I. Sayegh, None Program Number: 5559 Poster Board Number: A0168 Presentation Time: 8:30 AM–10:15 AM Tele-Ophthalmology Research in Post Phacoemulsification Diagnostic Outcomes (TORPEDO) Study - Phase 1 and 2 Results Xiu Ling Tan1, 2, Francine Yang1, 2, Hon Kiat Wong1, 2, Tock Han Lim1, 2 1 . Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore; 2 National Healthcare Group Eye Institute, Singapore, Singapore. Purpose: To evaluate the accuracy of tele-medicine in detecting post-phacoemulsification outcomes and complications at the onemonth post-operative visit, as compared to a face-to-face clinical consultation. Phase 1 (validation phase) aims to assess the accuracy of tele-ophthalmology in detecting clinical parameters relevant to a one-month post-phacoemulsification review; while Phase 2 is a pilot trial of a targeted and novel telemedicine workflow (TeleOph) specifically designed for a one-month post-phacoemulsification consultation. Methods: In phase 1, 80 patients who had undergone phacoemulsification surgery were recruited. This consisted of 20 patients with corneal pathology post-phacoemulsification, 20 with anterior chamber inflammation, 20 with intraocular lens or posterior capsule-related pathology and 20 controls. Anterior segment photography was performed. In phase 2, a prospective study of 30 patients who underwent uneventful phacoemulsification surgery was conducted. At the one-month post-operative visit, patients underwent the TeleOph work-flow which included refraction, intraocular pressure measurement, and slit-lamp and fundus photography. In both phases, images were then read by a masked investigator and compared against the clinical findings of a face-to-face consultation conducted at the same visit. Results: In Phase 1, anterior segment photography detected corneal pathology with a sensitivity and specificity of 100%; anterior chamber inflammation with a sensitivity of 100% and specificity of 95% and the presence of intraocular lens or posterior capsule-related pathology with a sensitivity of 95% and specificity of 85%. In Phase 2, TeleOph detected corneal and wound-related complications with a sensitivity and specificity of 100%; anterior chamber inflammation with a sensitivity of 75% and specificity of 92.3% and the presence of posterior capsular opacification with a sensitivity of 100% and specificity of 96.6%. Conclusions: Tele-medicine detects post-phacoemulsification outcomes and complications with a high level of sensitivity and specificity. It best detects corneal and intraocular lens-related complications; with a lower sensitivity and specificity in detecting anterior chamber inflammation. Commercial Relationships: Xiu Ling Tan, None; Francine Yang, None; Hon Kiat Wong, None; Tock Han Lim, None Program Number: 5560 Poster Board Number: A0169 Presentation Time: 8:30 AM–10:15 AM Pilot Study Using Mobile Health to Coordinate the Diabetic Patient, Diabetologist and Ophthalmologist Irena Tsui1, Andrew Drexler2, Annette Stanton3, Jenny Kageyama1, Bradley R. Straatsma1. 1Ophthalmology, JSEI, Los Angeles, CA; 2 Endocrinology, UCLA, Los Angeles, CA; 3Psychology, UCLA, Los Angeles, CA. Purpose: To use a mobile app to empower patients and increase communication among the diabetic patient, diabetologist and ophthalmologist. Methods: Patients with Type 1 or Type 2 diabetes mellitus and access to a mobile device were invited to participate. Intervention was use of SightBook™, a free mobile app that monitors visual acuity at home and allows communication between the patient and multiple physicians. Outcome measures included psychosocial surveys, use of the mobile app, and participation by the diabetologist and ophthalmologist. Results: Sixty patients were enrolled with a mean age of 45 years (range 23 - 81). Self-administered health psychology questionnaires in 45 patients showed varied diabetes knowledge and disease perception. At baseline, mean A1c was 8.6 and 30% of patients had diabetic retinopathy. Twenty-nine patient profiles (48%) were successfully complete 3 months after enrollment (Table). Conclusions: Diabetic patients responded enthusiastically to using mHealth; however, heavily burdened physicians were reluctant to take on the task of entering data that duplicated medical records. Additional study is required to improve mHealth technology for better incorporation into patient care. Commercial Relationships: Irena Tsui, None; Andrew Drexler, None; Annette Stanton, None; Jenny Kageyama, None; Bradley R. Straatsma, None Support: Oppenheimer Grant Clinical Trial: NCT01983917 ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5561 Poster Board Number: A0170 Presentation Time: 8:30 AM–10:15 AM Association between government-insured general eye exams and incidence of self-reported glaucoma, cataracts and uncorrectable vision loss Yaping Jin1, 2, Elizabeth Badley3, 2, Graham E. Trope1, Yvonne M. Buys1, Christina Chan3. 1Ophthalmology & Vis Sci, University of Toronto, Toronto, ON, Canada; 2Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 3Arthritis Research and Evaluation Unit, Toronto Western Research Institute, Toronto, ON, Canada. Purpose: To determine if there is an association between government-insured general/routine eye exams and incidence of self-reported glaucoma, cataracts and uncorrectable vision loss (i.e. unable to see close or distance with eyeglasses). Methods: We analyzed self-reported data from the Canadian longitudinal National Population Health Survey run from 1994/1995 to 2010/2011, which represents a 16-year follow-up. Standardized questionnaires were used to collect data every two years. White respondents aged 65+ in 1994/1995 were included (n=2,618). Three cohorts were established at baseline: those free of glaucoma, those free of cataracts and those free of uncorrectable vision loss. Incident cases were identified through self-reporting of the conditions in question in the follow-up period. Government insurance for general/ routine eye exams was assigned based on reported respondent’s province of residence in 1994/1995 and their corresponding provincial health insurance policy. Incidence rate ratios (IRRs) were calculated to compare the risk of incidence in government insured versus uninsured populations, controlling for age, sex, education, and smoking. Results: The incidence rate (per 1000 person-years) of self-reported glaucoma was higher in government-insured seniors (12.8, 95% confidence interval [CI] 10.5-15.1) than uninsured seniors (8.1, 95% CI 5.5-10.7). For cataracts, the incidence was also higher in the insured: 75.7 (95% CI 69.2-82.2) versus 67.2 per 1000 person-years (95% CI 55.7-78.6). For uncorrectable vision loss, the incidence was lower in the insured: 22.5 (95% CI 20.0-25.5) versus 26.6 per 1000 person-years (95% CI 20.2-33.0). Adjusting for confounding factors, insured seniors were associated with a 59% increased risk of being diagnosed with glaucoma (IRR 1.59; 95% CI 1.07-2.37), a 13% greater risk of being diagnosed with cataracts (IRR 1.13, 95% CI 0.93-1.37) and a 12% reduced risk of reporting uncorrectable vision loss (IRR 0.88, 95% CI 0.67-1.16). Conclusions: Government-funded general/routine eye exams are associated with a higher incidence of self-reported glaucoma and cataracts, likely due to better detection. Insured eye exams are also associated with a lower incidence of uncorrectable vision loss, likely due to better access to eye care and earlier treatment for preventable/ avoidable vision loss. Commercial Relationships: Yaping Jin, None; Elizabeth Badley, None; Graham E. Trope, None; Yvonne M. Buys, None; Christina Chan, None Support: CIHR SEC 117120, CIHR HRA 126901 Program Number: 5562 Poster Board Number: A0171 Presentation Time: 8:30 AM–10:15 AM Low Utilization of Eye Care Providers by Newfoundland and Labrador Seniors: Barriers and Vision Health Outcomes Kangping Cui1, Graham E. Trope1, 2, Yvonne M. Buys1, 2, Christina Chan2, Kednapa Thavorn3, Yaping Jin1, 4. 1Ophthalmology and Vision Siences, University of Toronto, Toronto, ON, Canada; 2Toronto Western Research Institute, University Health Network, Toronto, ON, Canada; 3Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Purpose: A prior study revealed significantly lower use of eye care providers in Newfoundland and Labrador (NFLD) than other Canadian provinces. We examined factors associated with this low use and evaluated vision health outcomes. Methods: Descriptive analyses with 95% confidence intervals (CI) were performed using self-reported data from Caucasians aged 65+ who participated in the Canadian Community Health Survey Healthy Aging 2008/09 (n=14,925). Results: The NFLD government, along with PEI, NB, and SK, does not insure seniors without eye disease for routine eye exams. All other Canadian provinces insure seniors regardless of eye conditions. Among people without self-reported glaucoma, cataracts and diabetes, the use of eye care providers in NFLD (36.3%) was the lowest compared to provinces with (50.7%, p<0.05) and without (42.2%, p>0.05) insured eye exams. Among seniors with an eye disease, who are insured in all provinces, use in NFLD (63.1%) was still lower than other provinces (69.4%-71.3%, p>0.05). Lower levels of socioeconomic status and living in non-urbanized areas were associated with reduced use of eye care providers across Canada. Compared to the national average, NFLD seniors had significantly lower levels of education (46.4% vs. 57.8% for postsecondary education), income (11.9% vs. 21.5% for earning above the 70th national income percentile) and urban dwelling (59.4% vs. 81.1%). After adjusting for confounding effects, seniors in NFLD were 15% (prevalence ratio [PR] 0.85, 95% CI 0.77-0.94) and 9% (PR 0.91, 95% CI 0.82-1.02) less likely to use an eye care provider than those in provinces with and without government-insured routine eye exams. The prevalence of self-reported glaucoma was significantly lower in NFLD (3.8%) than in provinces with (7.0%) and without (6.7%) government-insured routine eye exams. The same was true for selfreported cataracts: 16.7% in NFLD vs. 23.2% in insured provinces. The prevalence of uncorrectable vision loss (i.e. unable to see close or distance with eyeglasses) was higher in NFLD than in insured provinces (4.0% vs. 3.5%, p>0.05). Conclusions: Lack of government insurance, low levels of income and education, living in non-urbanized areas may contribute to the underutilization of eye care providers in NFLD. This low utilization seems to be associated with reduced detection of eye disease and increased prevalence of uncorrectable vision loss. Commercial Relationships: Kangping Cui, None; Graham E. Trope, None; Yvonne M. Buys, None; Christina Chan, None; Kednapa Thavorn, None; Yaping Jin, None Support: The Canadian Institutes of Health Research (CIHR) (CIHR SEC 117120, CIHR HRA 126901) and Institute of Medical Sciences (IMS) summer research program joint funding award (University of Toronto) ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5563 Poster Board Number: A0172 Presentation Time: 8:30 AM–10:15 AM : Inter-observer agreement and sensitivity – specificity analysis of a technology led, remote review glaucoma clinic Jonathan C. Clarke, Renata Puertas, Paul J. Foster, Keith Barton. NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom. Purpose: Patients with well controlled glaucoma and ocular hypertension are suitable for follow up assessment in “remote review clinics”. The clinical findings and investigations are collected at one site and the results analysed by a glaucoma physician at another site at a later time. The separation of data acquisition and clinical decision making can lead to an improved patient experience and workflow. Although this type of clinic set up exists, there is little information concerning the safety or physician agreement. We investigate the safety and level of clinical agreement of a remote review glaucoma clinic. Methods: Low risk patients were selected by reviewing the clinical notes of a general adult glaucoma clinic. Patients were reviewed clinically after all the appropriate investigations to assess glaucoma were performed. A decision about stability was made. More than 1 year later, the same clinicians reviewed the data collected and decided whether the glaucoma appeared stable or unstable. These outcomes are compared between physicians as a measure of inter-observer agreement. A sensitivity and specificity assessment comparing clinical decision making and remote decision making is performed. Results: The records of 871 patients were assessed and 286 were invited to participate and 217 accepted. There were sufficient data collected by both clinical systems to allow accurate decision making in 200 patients. Inter-observer agreement was moderate with kappa scores of 0.50 (95% CI 0.374 to 0.619). For the more senior physician, 8 of 116 patients (6.9%) were progressing in the clinical examination and 6 of these patients were identified remotely with sensitivity of 75.0% and specificity 79.6%. The remaining 2 patients were slowly progressing and diagnosis is likely to have been made if imaging data were available in the remote review system. Conclusions: Telemedicine and remote review medical assessments are increasingly common systems for treating patients. The safety of these systems has not been reliably assessed. We conclude that there is moderate agreement between two assessors of a group of stable glaucoma patients. Sensitivity of the system to detect progression is likely to improve if the data is presented systematically by an electronic patient record. Commercial Relationships: Jonathan C. Clarke, None; Renata Puertas, None; Paul J. Foster, None; Keith Barton, None Program Number: 5564 Poster Board Number: A0173 Presentation Time: 8:30 AM–10:15 AM Comparison of two diabetic retinopathy screening program models within a single primary care practice Kristina Holbrook, Kerry Cotter, Paul A. Yates. Ophthalmology, University of Virginia, Charlottesville, VA. Purpose: To evaluate factors that determine the effectiveness of tele-ophthalmic screening programs for diabetic retinopathy (DR) by comparing two successive implementations at a primary care practice that serves the largest population (N=2570) of adults with diabetes mellitus at the University of Virginia. Methods: In 2006, a DR screening program was established using the Optos wide-field retinal imager (Optos Program). Digital images of each eye using the non-mydriatic, 200-degree retina view were obtained by multiple nurses at physician request and read by a UVA ophthalmologist in a time frame consistent with the patient’s ongoing consultations. Results were communicated to the ordering physician. The program was active until 2009, when the system was removed due to unsatisfactory outcome measures relative to cost-effectiveness. In September 2011, a revised DR screening program was established at UMA (DRS Program). A single medical assistant obtained one 45° macula-centered image of each eye using a refurbished nonmydriatic camera (Topcon TRC-45N). The images were read by an ophthalmologist. Results and ophthalmic follow-up recommendations were shared with the ordering physician and patient within 48 hours of screening. To evaluate program success, we compared number of patients screened, number of cases of DR, number of patients identified with other retinal pathology, and the ophthalmic follow-up visit compliance rate in patients with suspected DR. Results: The Optos Program screened 186 patients in 36 months and the DRS Program screened 1348 in 26 months. DR was detected in 29 (16%) patients in the Optos Program and 253 (19%) in the DRS Program. Positive screens (with DR) identified via the DRS Program were more compliant with their ophthalmic follow-up visit recommendation (71% compliance) than those identified via the Optos Program (34% compliance). Conclusions: Multiple factors enabled the success of the latter program. The designation of a full-time nurse / photographer and integration of screening into the nursing workflow (a standing order is used) contributed to program success. Time associated with image transmission, review, and communication of results (< 48 hours) was decreased through the latter program. Directly involving the patient in the scheduling of the ophthalmic follow-up appointments contributed to the improved follow-up appointment completion rate. Commercial Relationships: Kristina Holbrook, None; Kerry Cotter, None; Paul A. Yates, Genentech / Roche (C), RetiVue, LLC (E), RetiVue, LLC (I), University of Virginia (P) Program Number: 5565 Poster Board Number: A0174 Presentation Time: 8:30 AM–10:15 AM Attitudes Toward Tele-ophthalmology Patricia Ple-plakon1, Paul P. Lee1, Taylor Blachley1, David C. Musch1, 2, Maria A. Woodward1. 1Ophthal & Visual Sciences, University of Michigan, Ann Arbor, MI; 2Epidemiology, University of Michigan, Ann Arbor, MI. Purpose: With the rapid rise of e-health and remote care systems, we sought to evaluate perspectives on and familiarity with telemedicine among eye care providers (ophthalmologists and optometrists) and emergency department (ED) physicians at a large tertiary care medical center. Methods: Anonymous surveys were administered to eye care providers and ED physicians at the University of Michigan to gauge current practice patterns and willingness to adopt telemedicine for eye care. Results were compared among trainees (residents and fellows) and faculty members and across specialties. Results: A total of 76 ED physicians (55.1% trainees, 42.3% faculty, 2.6% physician assistants and others) and 58 eye care providers (31.0% trainees, 69.0% faculty) completed surveys (response rates of 72% and 62%, respectively). Among eye care providers, while a majority of both faculty and trainees were willing to participate in telemedicine services, trainees were more likely to be willing to interpret photographs than faculty (p=0.04). Most respondents (71%) indicated that they did not use telemedicine, yet over half received photographs (via internet or email) for interpretation from referring physicians (54%) or patients (56%) within the past 3 months. At the same time, a majority (59%) had low confidence in remote screening for eye care as the only source of information for patient care. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Among ED physicians, 65% were already utilizing telemedicine for various specialties, and most were interested in tele-ophthalmology. A majority (80%) felt telemedicine in eye care was under-utilized in the ED. Interestingly, ED faculty were more likely than trainees to feel confident in using telemedicine services to decide upon appropriate patient eye care without an in-person ophthalmology consultation (p=0.01). Conclusions: While many providers see telemedicine as part of the future of eye care and its use is accepted by most, the majority of eye care providers (but not ED providers) had confidence issues regarding the use of telemedicine services alone in the care of patients. Commercial Relationships: Patricia Ple-plakon, None; Paul P. Lee, None; Taylor Blachley, None; David C. Musch, None; Maria A. Woodward, None Support: Dr. Maria Woodward with NIH K23 Career Development Award NIH1K23EY023596-01 Program Number: 5566 Poster Board Number: A0175 Presentation Time: 8:30 AM–10:15 AM Frequency of Gonioscopy and Pachymetry on First Visit Glaucoma Patients Stephanie Ma1, Satyesh Rana1, Justin Tannir2, Bret Hughes2, Aman Shukairy2, Saya Nagori2, Mark S. Juzych2, Anju Goyal2. 1Wayne State University School of Medicine, Detroit, MI; 2Ophthalmology, Kresge Eye Institute, Detroit, MI. Purpose: To study the frequency that gonioscopy and pachymetry is done and billed for on first visit glaucoma patients and measure lost revenue. Methods: The most recent patients for first ophthalmology visits given the diagnosis of glaucoma with an ICD code of 365.xx at the Kresge Eye Institute were used to form a patient list. These patients were seen from May 2013 to Aug 2013. Patients were then organized as being seen by a glaucoma specialist or non-glaucoma specialist. All patients were further identified as seen in a private clinic or resident clinic. 980 right eyes were used in the study using electronic medical records to obtain relevant data. We recorded whether gonioscopy and pachymetry was completed during this first visit. A revenue analysis was done using a percentage of patients on various insurance coverage plans, as well as the reimbursement given by each plan for gonioscopy and pachymetry. Results: Our results indicate that gonioscopy and pachymetry are under utilized. Among the 980 patients in our study, 17.96% of patients had gonioscopy performed on their initial visit. The specialty training of the ophthalmologist seeing the patient as well as the setting of the initial visit appeared to play a role in whether or not gonioscopy was done. Gonioscopy was performed more often by glaucoma doctors in their private clinics 47.57% than by non-glaucoma doctors in private clinic 5.88% (P-value <0.0001). Gonioscopy was performed even less often by glaucoma doctors in resident clinic 18.75% and by non-glaucoma doctors in resident clinic 8.14% compared to glaucoma doctors in private clinic (P-value <0.0001). Pachymetry was performed more often by glaucoma doctors in their private clinics 67.04% than by non-glaucoma doctors in private clinic 23.74%. Pachymetry was performed even less often by glaucoma doctors in resident clinic 12.5% than by non-glaucoma doctors in resident clinic 14.50%. These differences were statistically significant (P-value <0.0001). Based on insurance types and reimbursement for the Kresge Eye Institute, we estimate lost revenue to be $32,265.40 in these 980 patients during 5/3/13-09/13/13. Conclusions: Goniscopy and pachymetry are not optimally performed or billed for on first visit glaucoma patients at the Kresge Eye Institute. Practice patterns for glaucoma can be ignored and institutions can lose revenue failing to bill for these procedures. Commercial Relationships: Stephanie Ma, None; Satyesh Rana, None; Justin Tannir, None; Bret Hughes, None; Aman Shukairy, None; Saya Nagori, None; Mark S. Juzych, None; Anju Goyal, None Program Number: 5567 Poster Board Number: A0176 Presentation Time: 8:30 AM–10:15 AM An Analysis of Optometry Referrals to Ophthalmology for Glaucoma Suspects Catriona Barrett1, 2, Colm J. O’Brien2, James Loughman1. 1 Optometry, Dublin Institute of Technology, Dublin, Ireland; 2 Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland. Purpose: The glaucoma care pathway in Ireland comprises an optometrist-led glaucoma screening service, with referrals channeled into ophthalmology services. Recent findings indicate a 31% false positive referral rate for suspect glaucoma, a factor that exacerbates the problem of escalating waiting lists in an under-resourced public health system. This study was designed to assess the quality of glaucoma referrals from optometry as a means to understand current practice in the context of a critical need to enhance the public health optometry role. Methods: This study involved an analysis of glaucoma referrals from all 59 optometrists participating in a joint optometry/ophthalmology glaucoma referral refinement scheme at the National Optometry Centre, Dublin. Each of the 181 referrals included was assessed in terms of the (i) screening techniques used, (ii) clinical findings provided and (iii) comparison with clinical findings in the glaucoma clinic. Results: Non-contact tonometry (NCT) emerged as the primary clinical finding reported in the majority of referrals (98%), compared to optic disc description (87%), visual field assessment (70%), risk factor profile (62%) and cup-disc ratio (61%). Only 39% of referrals contained a copy of the visual field plot, while a disc height measurement was only provided in one referral (the method of disc assessment was typically not provided). Only 5% of intraocular pressure (IOP) measures were taken using Goldmann tonometry (GAT), and corneal thickness (CCT) measures reported in 3 cases. A statistically significant difference was observed between NCT values reported by the optometrists and both the raw GAT (mean difference = 0.99; p = 0.002, Bland Altman limits of agreement of ± 8.18mmHg), and CCT corrected GAT (mean difference = 2.39; p = 0.000, Bland Altman limits of agreement of 11.47mmHg) obtained in the glaucoma clinic. Cup-disc ratio measures reported in the referrals were not significantly different from those recorded in the clinic (mean difference ± SD = 0.01 ± 0.11; p = 0.393), although Bland Altman limits of agreement of ± 0.22 were observed. Conclusions: Glaucoma referrals show a pattern of reliance on NCT and isolated CD ratios, which provide measures that are outside clinically acceptable limits of agreement with gold standard techniques. To improve the accuracy of glaucoma referrals, optometrists should adopt the use of GAT, CCT, disc measurement and dilated examination. Commercial Relationships: Catriona Barrett, None; Colm J. O’Brien, None; James Loughman, None Support: Support grant from the Association of Optometrists Ireland ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5568 Poster Board Number: A0177 Presentation Time: 8:30 AM–10:15 AM Comparison of eye disease diagnosis by optometrists and ophthalmologists in Ampang, Malaysia Duratul A. Hussin1, Andrew Carkeet1, Peter Hendicott1, Philip Baker2, Ai-Hong Chen3. 1School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia; 2School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia; 3 Department of Optometry, Universiti Teknologi MARA, Puncak Alam, Malaysia. Purpose: Optometrists in Malaysia receive a minimum of 4 years university training and have skills comparable with optometrists in many developed countries. However, as primary eye care clinicians, these optometrists’ skills are relatively underutilized. To assess the potential to improve health care efficiency, we assessed the diagnostic abilities of Malaysian-trained optometrists against ophthalmologists in detecting presence of cataract, diabetic retinopathy and glaucoma. Methods: Two consultation rooms were set-up at a community clinic and a hospital eye clinic in Ampang, Malaysia. Eight optometrists and four ophthalmologists participated. Initially optometrists received a refresher course in diagnosis and management decision making for common eye diseases, and eye examination skills. Consecutive patients who gave written informed consent were initially examined by an optometrist and then re-examined by an ophthalmologist masked to the optometrist’s diagnosis. Results: Fifty-six patients participated, of whom, 42 patients had been already diagnosed with diabetes mellitus prior to recruitment to the study. Of these patients, 43 (86 eyes) were re-examined by an ophthalmologist and included in the analysis. Of these, 26 patients were known to have diabetes mellitus. Optometrists diagnosed cataracts in 37 eyes, diabetic retinopathy in 9 eyes and suspected glaucoma in 16 eyes. Ophthalmologists diagnosed cataracts in 39 eyes, diabetic retinopathy in 11 eyes and suspected glaucoma in 18 eyes. Diagnostic test characteristics and predictive values for optometrists diagnosis (compared with the standard of ophthalmologist diagnosis) for the three conditions are shown below. Conclusions: In this study, Malaysian optometrists, even when inexperienced in primary eye care, could demonstrate high accuracy in detecting presence of a disease particularly cataract and glaucoma. However, based on the small number of cases detected by ophthalmologists (6 eyes), optometrists’ performance in detecting the presence of diabetic retinopathy was moderate. Better sensitivity may be achieved as Malaysian optometrists gain more experience with disease detection and diagnosis. Diagnostic test and predictive values for detecting presence of cataract, diabetic retinopathy and glaucoma by the optometrists Commercial Relationships: Duratul A. Hussin, None; Andrew Carkeet, None; Peter Hendicott, None; Philip Baker, None; AiHong Chen, None Support: MRG Grant ID11483, Ministry of Health Malaysia. Program Number: 5569 Poster Board Number: A0178 Presentation Time: 8:30 AM–10:15 AM The Effectiveness of Vision Screening for Visual Problems in School Children Ellen Svarverud, Trine Langaas, Helle K. Falkenberg. Dept of Optometry and Visual Science, Buskerud and Vestfold University College, Kongsberg, Norway. Purpose: As an integral part of their clinical training, Norwegian optometry students participate in vision screening in Kongsberg’s 13 primary schools for children aged 7, 10 and 15 years. The screening is a unique agreement between the optometry department and the municipality as no national guidelines exists for eye examinations in school children after the age of four years. The screening includes a symptom questionnaire and assessment of best corrected visual acuity (BCVA), retinoscopy, phorias, convergence, accommodation, ocular motility, and stereo and color vision. All children failing the screening criteria are referred to the departmental clinic for a full eye examination. This study aims to validate the vision screening scheme with regards to relevance of criteria and the ability to correctly identify children who need vision treatment and follow up. Methods: Screening records from 7658 children aged 7 (34%), 10 (34%) and 15 (33%) years between 2002 and 2012 were evaluated. Records from children referred to the clinic were analyzed with regards to reasons for referral and the outcome of the full eye examination. Results: 1126 (14.7%) children were referred. The most frequent reason for referral was visual symptoms (39%, 53% and 33% for 7, 10 and 15 year olds, respectively). Significant hypermetropia was measured in 14%, 16% and 9% of the 7, 10 and 15 year olds, and myopia in 3%, 7% and 16%. Other reasons for referral were reduced BCVA in the 7 year olds (15%), reduced accommodation, convergence and stereo vision in the 7 and 10 year olds (15-18%), while these reasons for referral were less frequent in 15 year olds (10-11%). Of the 856 who attended the clinic, treatment or further follow up was recommended in 594 (69%) cases. The number of true referrals increased with age and was 63%, 77% and 86% for 7, 10 and 15 year olds, respectively. Conclusions: Our results suggest that visual screening correctly identifies many school children who have undetected visual problems, and that visual problems differ across age groups. However, the false referral rate is high in the youngest age group, which may be due to insufficient routines and lack of experience in assessing vision in young children. Currently, improvements to the vision screening scheme include discussion of criteria for referral, student training prior to screening, check lists for supervisors and screening facilities. Commercial Relationships: Ellen Svarverud, None; Trine Langaas, None; Helle K. Falkenberg, None Support: Norwegian Association of Optometry Program Number: 5570 Poster Board Number: A0179 Presentation Time: 8:30 AM–10:15 AM Outcomes of Large Sample Vision Screening among School Children Aged 7-15 Years in Norway Helle K. Falkenberg, Trine Langaas, Ellen Svarverud. Department of Optometry and Visual Science, Buskerud and Vestfold University College, Kongsberg, Norway. Purpose: As part of their clinical training, Norwegian optometry students vision screen 7, 10 and 15 year olds children in Kongsberg’s 13 primary schools. All children failing the screening criteria are referred to the departmental clinic. This study presents visual function data from school children between 2002 and 2012. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Methods: 1126 (14.7%) of 7658 children, were referred, and 856 attended a full eye examination. Outcomes and visual status, including symptoms, refractive error, best corrected visual logMAR acuity (BCVA), binocular vision assessment and ocular health were analyzed. Results: 594 (69%) children needed treatment, and recommendations were: glasses (60%), vision training (12%), further follow-ups (30%), referral to an ophthalmologist (4%). Glasses were recommended primarily for low hypermetropia in 7 year olds and for near vision problems in 10 yearl olds. There was a significant increase in the number of myopes in 15 year olds. Vision training was also recommended for 10 and 15 year olds. The most prevalent symptoms were near vision problems (33%), headaches (29%), and reduced distance vision (25%). BCVA was -0.03 ± 0.1, -0.08 ± 0.11, and -0.06 ± 0.11 for 7, 10 and 15 year olds respectively. Refractive (spherical equivalent) errors were +0.8 ± 0.7 DS, +0.5 ± 1.1 DS, and -0.2 ± 1.0 DS, and binocular accommodation was 14 ± 4.5 DS, 13 ± 4.5 DS, and 11 ± 3.5 DS respectively. Heterophorias were 0,8 ± 2,7 exophoria for distance and 2,5 ± 4 exophoria for near, and near point of convergence was 8 ± 7 cm across all children. False referrals were 37%, 23% and 14% for the three age groups. Conclusions: The results show that visual screening correctly identifies many school children who have undetected visual problems. Importantly, most of these problems can be helped with glasses and/or vision training. This study shows that the overall visual status of Norwegian school children on average are as expected with regards to their age, and that the visual system continues to develop during primary school. Further, the type of visual problem changes over time which stresses the importance of eye examinations at regular intervals, and raised awareness among parents and teaching staff. Commercial Relationships: Helle K. Falkenberg, None; Trine Langaas, None; Ellen Svarverud, None Support: The Norwegian Association of Optometry Program Number: 5571 Poster Board Number: A0180 Presentation Time: 8:30 AM–10:15 AM National Burden of Eye Diseases in Iran 1990-2010; Findings from the Global Burden of Disease Study 2010 Elham Hatef Naimi1, Seyed Farzad Mohammadi2, Elham Ashrafi2, Cyrus Alinia2, Mehrdad Mohammadi2, Farshad Farzadfar3. 1General Preventive Medicine Residency Program, Johns Hopkins University, Baltimore, MD; 2Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; 3 Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran. Purpose: To evaluate national burden of eye diseases in Iran and to compare changes in the burden from 1990 to 2010 by age and sex. Methods: Disability-adjusted life-years (DALYs) in Iran is reported for 4 different eye diseases including cataract, refraction/ accommodation (functional) disorders, macular degeneration, and glaucoma, using “the Global Burden of Disease Study 2010. Iran Global Burden of Disease Study 2010 (GBD 2010) Results 1990-2010. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2013”. DALY for each disease is compared between 1990 and 2010, among 20 age groups from early neonatal phase to 80 years of age and older and among males and females. Results: In Iran, cataract, refraction/accommodation (functional) disorders, macular degeneration, and glaucoma were the 84th, 87th, 138th, and 151st causes of DALY in 1990 and 89th, 72nd, 99th, and 137th in 2010, respectively. Cataract accounted for 0.085% of national DALY in 1990 and 0.09% in 2010, refraction/ accommodation (functional) disorders accounted for 0.42% in 1990 and 0.47% in 2010, macular degeneration accounted for 0.017% in 1990 and 0.071% in 2010, and glaucoma accounted for 0.0099% in 1990 and 0.025% in 2010. There was steady increase in DALY with age for each eye disease for both genders and among males and females in 1990 to 2010. The point-by-point comparison of DALY attributed to cataract and refraction/accommodation (functional) disorders showed a decrease for each specific age group from 1990 to 2010 for both sexes and among males and females. For macular degeneration it showed an increase for each specific age group from 1990 to 2010 for both sexes and among males and females. For glaucoma it showed slight change for each specific age group from 1990 to 2010 for both sexes and among males and females with slight decrease in some age groups and slight increase in others. Conclusions: Total DALY and relative contribution to national disease burden of vision-impairing conditions have increased which underscore the age-related nature of blinding conditions and epidemiologic transition. This is most evident in case of macular degeneration. The point-by-point decrease in DALY related to functional visual impairment and cataract is attributable to the treatability of these conditions and popularity and effectiveness of cataract surgery. Commercial Relationships: Elham Hatef Naimi, None; Seyed Farzad Mohammadi, None; Elham Ashrafi, None; Cyrus Alinia, None; Mehrdad Mohammadi, None; Farshad Farzadfar, None Program Number: 5572 Poster Board Number: A0181 Presentation Time: 8:30 AM–10:15 AM Demographic and Clinical Profile of a Homeless Population Presenting to an Ophthalmology Outreach Clinic Brian Stagg, Brad Henriksen, Max Padilla, Bryce Radmall, Erica Liu, Jason Jensen, Aabid Farukhi, Jeff Pettey, Albert T. Vitale. John A Moran Eye Center, Salt Lake City, UT. Purpose: To evaluate the demographics, chief complaint, and diagnoses of patients presenting to an ophthalmology clinic for homeless populations. Methods: Retrospective chart review of all patients seen at an eye clinic dedicated to homeless patients from 2008 to 2013. Results: 178 individual patients were seen, with a total of 238 clinic visits. All patients were homeless with 66% male and 34% female. The average age was 50. The most common chief complaint was decreased vision (29% of visits) followed by diabetic eye screening (27%), glaucoma evaluation (9%), eye pain (5%), growth on eye (3%), and red eye (3%). Only 2.5% of the patients evaluated had a normal exam. The most common diagnosis was cataract (35% of visits), followed by NPDR (13%), refractive error (11%), glaucoma (8%), glaucoma suspect (7%), dry eye syndrome (7%), thyroid eye disease (4%), ocular misalignment (3%), pterygium (3%), and conjunctivitis (3%). Follow-up was recommended in 60% of visits; however, of these patients, only 36% were seen again. Conclusions: This study provides an important snapshot of ocular health in a relatively unstudied patient population. In this setting, homeless patients were very likely to have ocular pathology, with only 2.5% having a normal eye exam. Chronic blinding diseases such as diabetic retinopathy and glaucoma were present in a significant portion of the homeless population. These chronic diseases are especially difficult to treat in a population with socioeconomic challenges to consistent follow-up. Concerted efforts focused on the treatment and longitudinal follow-up of chronic ocular disease in indigent populations are necessary. Commercial Relationships: Brian Stagg, None; Brad Henriksen, None; Max Padilla, None; Bryce Radmall, None; Erica Liu, None; Jason Jensen, None; Aabid Farukhi, None; Jeff Pettey, None; Albert T. Vitale, None ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5573 Poster Board Number: A0182 Presentation Time: 8:30 AM–10:15 AM Stakeholder Perceptions and Practices Regarding the Ocular Effects of Hyperbaric Oxygen Therapy Arjun J. Dirghangi1, Brian K. Lee2, Amanda Allan4, Krish Gandhi3, Amanda Y. Lehman1. 1Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA; 2Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA; 3Drexel University College of Medicine, Philadelphia, PA; 4Drexel University School of Health Professions, Philadelphia, PA. Purpose: The purpose of this study is to determine the perceptions and practices of practitioners of hyperbaric oxygen therapy (HBOT) regarding its ocular effects. HBOT is a commonly used therapy with many indications (most commonly used for non-healing diabetic ulcers and burn injuries), but a highly limited evidence base regarding ocular risks and benefits. Patients receiving HBOT are referred to ophthalmologists to “clear” them prior to therapy based upon theoretical risks of oxidative stress; this incurs a significant burden upon the health system, with unclear benefits and clinical follow-up. Methods: This study uses a combination of quantitative and qualitative research methods, primarily relying upon quantitative KAP (knowledge, attitudes, and practices) survey techniques administered to physicians and technicians evaluating and treating patients for HBOT (general surgeons, radiation oncologists, and ophthalmologists) in an urban academic teaching hospital. Additionally, focus group discussions (FGDs) were held with smaller groups, including HBOT patients, to collect complementary qualitative data. Finally, a retrospective chart review was conducted of all patients consulted for ophthalmic evaluation prior to initiation of HBOT over the past two years. Results: The knowledge base of surveyed practitioners was variable. Though 69% of respondents stated ophthalmic clearance was necessary prior to initiation of HBOT, 63% of respondents had only some or no knowledge of why such clearance was needed. Additionally, of those who felt clearance was necessary, none were able to correctly identify a contraindication to therapy without prompting. A significant percentage misidentified glaucoma (43%) and macular degeneration (14%) as contraindications to therapy. 60% felt HBOT causes either short- or long-term harm to the eye. Finally, an extremely low (2%) rate of outpatient follow-up of HBOT patients was found for subsequent ophthalmic evaluation. Conclusions: The current study reveals practice patterns instructive to relevant practitioners involved with this common treatment. Gaps in knowledge identified in our study regarding HBOT’s effects upon the eye present targets for intervention, as well as a low rate of outpatient follow-up examinations, and will inform a prospective study of the direct ocular effects of HBOT, and an evidence-based protocol regarding ophthalmic evaluation of these patients. Commercial Relationships: Arjun J. Dirghangi, None; Brian K. Lee, None; Amanda Allan, None; Krish Gandhi, None; Amanda Y. Lehman, None Program Number: 5574 Poster Board Number: A0183 Presentation Time: 8:30 AM–10:15 AM Positioning-Related Ocular Complications of Minimally-Invasive Radical Prostatectomies Frank S. Siringo1, 2, Timothy Wen4, Christopher Diebert3, Benjamin Spencer3, 4. 1Ophthalmology, University of Colorado School of Medicine, Denver, CO; 2Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY; 3Urology, Columbia University College of Physicians and Surgeons, New York, NY; 4Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Purpose: To characterize positioning-related ocular complications of robotic-assisted radical prostatectomy, (RARP), compared to open radical prostatectomy (ORP), and laparascopic-assisted radical prostatectomy (LRP). Methods: A retrospective study using 2008-09 discharge information data in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Patients diagnosed with prostate cancer undergoing ORP, LRP, or RARP were included. Outcome measures included a positioning-related complication, increased inpatient costs, prolonged length of stay, and in-hospital mortality. Chi-square, Fisher’s exact tests and multivariable logistic regression models compared groups and assessed associations between covariates and outcomes of interest. Results: 175,699 patients diagnosed with prostate cancer underwent radical prostatectomy in 2008-09; some 61,656 (35.1%) had RARP, 2,682 (1.5%) LRP, and 111,361 (63.4%) ORP. A total of 698 (0.4%) patients experienced a positioning complication. Ocular complications were most common, (51.1%), with nonsignificant differences in rates of 0.22% in ORP/LRP, vs 0.17% in RARP (p<0.110). Visually threatening ocular complication rates (retinal vascular occlusion, angle closure glaucoma, ischemic optic neuropathy, unilateral blindness) for ORP/LRP and RARP were 0.15% and 0.07%, respectively. The only significant hospital covariate was high annual RP case volume (>101 procedures), and it was protective (OR = 0.45, 95% CI: 0.27, 0.72, p-value = 0.0011). Conclusions: This study is one of the first to assess positioning related ocular complications in a national population-based database. Despite prolonged steep trendelenburg positioning during RARP, vision-threatening ocular complications were more common in ORP/LRP. The primary limitation of the study was the use of administrative claims data, which lack detailed clinical information. However, the large national sample size increases the generalizability of our results. Commercial Relationships: Frank S. Siringo, None; Timothy Wen, None; Christopher Diebert, None; Benjamin Spencer, None ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5575 Poster Board Number: A0184 Presentation Time: 8:30 AM–10:15 AM Morbidity and Mortality Conference Using an Anonymous Audience Response System to Address Core Competencies in Ophthalmology Jessica Prince1, Lewis A. Eisen2, Jamie B. Rosenberg1. 1 Ophthalmology, Montefiore Med Ctr/Albert Einstein, Bronx, NY; 2 Critical Care, Montefiore Med Ctr/Albert Einstein, Bronx, NY. Purpose: To assess whether implementation of Morbidity and Mortality (M&M) conferences with anonymous audience response system enhances residency education in the ACGME core competencies. Methods: Every other month starting June 2013, an M&M conference was held for the ophthalmology department. Residents presented patients who had suffered morbidity such as vision loss or unexpected need for reoperation. In each presentation, the level of training (student, resident, fellow, attending) was asked, followed by 5-7 multiple choice questions throughout the presentation addressing one of the 6 core competencies. All questions were powered by www. polleverywhere.com, which allowed each participant to respond by text message and displayed all responses anonymously. The poll responses were discussed in real time, including a determination of which core competency was applicable. The last question in each presentation asked audience members if this format of M&M conference was useful. The responses were collected and analyzed. Results: Three cases were presented during two conferences using audience response polling software. During the case discussions, the following issues were addressed: appropriate patient follow-up, diagnostic evaluations, complete ophthalmologic examinations, surgical errors, and post-operative complications. The questions addressed all 6 core competencies: patient care, medical knowledge, practice based learning and improvement, systems based practice, professionalism, and interpersonal skills and communication. Sixteen people attended the first conference and fifteen people attended the second. Most audience members (54.8%) were residents, with medical students (25.8%), fellows (3.2%), and attending physicians (16.1%) also participating. The majority of participants (84.6%) agreed or strongly agreed that the format of the M&M conference was useful. Conclusions: M&M conferences play an integral role in residency education. Anonymous audience response systems can provide a method of addressing all core competencies in a way that promotes active participation. Commercial Relationships: Jessica Prince, None; Lewis A. Eisen, None; Jamie B. Rosenberg, None Support: Research to Prevent Blindness Methods: We identified all beneficiaries age ≥40 years old in a U.S. managed care network who underwent ≥1 cataract surgeries from 2001-2011. Next, we identified all enrollees who required inpatient hospitalization within 7, 14, 30, and 90 days following their initial cataract surgery. Logistic regression was performed to identify sociodemographic factors, medical comorbidities, and other factors that increased the odds of requiring hospitalization following cataract surgery. Results: Among the 72,160 persons who underwent cataract surgery, the proportions hospitalized within 7, 14, 30, and 90 days after surgery were 0.3%, 0.6%, 1.3%, and 4.1%, respectively. Among the subset of 11,795 persons who went into the surgery with no major medical comorbidities, the proportions hospitalized within 7, 14, 30, and 90 days were 0.12%, 0.22%, 0.45%, and 1.42%, respectively, or roughly one third the rate. Enrollees with a prior history of congestive heart failure, myocardial infarction, and renal disease had a 46%, 49%, and 62% increased odds of hospitalization within 7 days, relative to those without these conditions (p<0.05 for all conditions). Patients with dementia had a 117% increased odds of hospitalization (p<0.01). The odds of hospitalization increased by 39% with the presence of each additional comorbidity (p<0.0001). Those with ≥1 prior inpatient hospitalizations had a 124% increased odds of hospitalization within 7 days of cataract surgery (p<0.0001). Conclusions: The risk of hospitalization after cataract surgery is low, and is very low among those with no major pre-existing medical comorbidities. Opportunities may exist to reduce overall healthcare costs without adversely impacting patient safety by limiting the need for comprehensive preoperative evaluation and testing to those who have serious pre-existing medical comorbidities. Program Number: 5576 Poster Board Number: A0185 Presentation Time: 8:30 AM–10:15 AM Determinants of hospitalization after cataract surgery in a large managed-care United States population Sophia Y. Wang1, 2, Taylor Blachley1, John Ayanian3, Paul P. Lee1, Joshua D. Stein1. 1Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; 2Department of Ophthalmology, University of California, San Francisco, San Francisco, CA; 3Department of Health Care Policy, Harvard Medical School, Boston, MA. Purpose: Because little is known regarding the extent to which patients undergoing outpatient cataract surgery are at risk for requiring post-operative hospitalization, we sought to determine the proportion of patients undergoing cataract surgery who require subsequent inpatient hospitalization during the immediate postoperative period and to identify risk factors for hospitalization. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts This information would help train residents on how to provide eye care safely and effectively. Methods: A survey comprised of multiple choice and Likert-style questions was printed, packed, and mailed to residents’ care of their ophthalmology department addresses. The residents were given the option to respond on paper using the pre-stamped return envelope or online through a link provided to an identical online survey created through DatStat Illume 5.1. Two follow-up reminder letters were mailed in two-week intervals to those who had not responded. Descriptive statistics were used to analyze the survey results. Results: The survey was mailed to the 1049 US ophthalmology residents; 365 completed the survey, yielding a response rate of 34.7%. The majority of the respondents (88.5%; 323/365) indicated that their programs provided specific training in the prevention surgical errors. Most commonly, this training consisted of observing attending physicians (90%; 293/324) and adhering to OR policies or protocols (91%; 295/324). Most respondents (73%; 237/323) indicated that their training in the prevention of surgical errors was not formally assessed. A majority of respondents (66%; 205/309) reported that the most effective training was “Hands on experience with guidance from attending physician.” Most respondents (78.9%; 276/363) agreed that their respective programs provided adequate training on the prevention of surgical errors and 84% (305/363) agreed that the public expected them to receive this training. Conclusions: This survey provides an educational blueprint for ophthalmic GME in preventable surgical errors that is responsive to resident preferences. It suggests that ophthalmology residents believed that hands-on experience with guidance from attending physicians was the most effective training to minimize surgical errors. This survey provides insight on how to improve the educational experience for residents with the goal of lowering the risk of preventable surgical errors in the future. Commercial Relationships: Allison Chen, None; Annika Havnaer, None; Paul B. Greenberg, None Commercial Relationships: Sophia Y. Wang, None; Taylor Blachley, None; John Ayanian, None; Paul P. Lee, None; Joshua D. Stein, None Support: National Eye Institute K23 Mentored Clinician Scientist Award (1K23EY019511) (JDS); Research to Prevent Blindness Physician Scientist Award (JDS) Program Number: 5577 Poster Board Number: A0186 Presentation Time: 8:30 AM–10:15 AM Training on the Prevention of Surgical Errors in Ophthalmology: the Resident Perspective Allison Chen, Annika Havnaer, Paul B. Greenberg. Alpert Medical School of Brown University, Providence, RI. Purpose: Surgical errors involving the wrong patient, wrong site (e.g. wrong eye) or wrong procedure (e.g. wrong intraocular lens implant) can have devastating consequences and are largely preventable by adherence to specific protocols. Little is known about the resident perspective on current training in the prevention of surgical errors. Program Number: 5578 Poster Board Number: A0187 Presentation Time: 8:30 AM–10:15 AM Improving the Transition to Ophthalmology Residency: A Survey of First-Year Ophthalmology Residents Travis Redd1, Akshay Thomas2, Thomas S. Hwang2. 1School of Medicine, Oregon Health & Science University, Portland, OR; 2 Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR. Purpose: The transition from internship to residency is a highly stressful period for ophthalmologists in training. This study quantifies the impact of this process and identifies ways to ease the transition. Methods: A 20-question electronic survey was sent to all directors of accredited ophthalmology residency programs in the US for distribution to their 1st year trainees. Statistical analysis included frequency tables and comparative testing using χ2 and t-tests. Results: 91 1st year residents responded, with an unknown denominator (minimum response rate 20%). 63% identified the transition to ophthalmologic training as more stressful than internship. Residents did little advance preparation for ophthalmology residency, and 50% regretted this. Comparative testing showed that independent preparation (p 0.002) and doing an ophthalmology rotation during internship (p 0.04) significantly reduced stress, and that those doing a transitional year were significantly more likely to do either (p 0.008). During orientation to ophthalmology residency, trainees identified hands-on exam sessions as most helpful, and didactic sessions as least helpful. Comparative testing showed that orientations dedicating more time to exam skills (p 0.005) and relationship-building (p 0.04) were associated with significantly ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts lower stress, while residents who felt inadequately oriented to logistics (p 0.01) and had relatively shorter buddy-call systems (p 0.02) were significantly more stressed. Conclusions: This survey identified the transition to ophthalmology residency as a highly stressful period. Key findings include: 1) Time spent preparing for ophthalmology residency is crucial to easing this transition. 2) A transitional PGY-1 year affords more opportunity to prepare for ophthalmology residency than preliminary medicine or surgery. 3) Orientations which provide more hands-on experience, relationship-building, and familiarity with logistics reduce stress among new residents, whereas longer orientations and didactic teaching do not. 4) Longer buddy-call systems produce significantly lower stress. These results can inform better independent preparation on the part of trainees and development of more effective orientation programs among ophthalmology residencies. Stress experienced during the first two months of ophthalmology residency, grouped by survey responses regarding level of preparation and orientation experience. Commercial Relationships: Travis Redd, None; Akshay Thomas, None; Thomas S. Hwang, None Program Number: 5579 Poster Board Number: A0188 Presentation Time: 8:30 AM–10:15 AM Mindfulness Training to Increase Resilience and Decrease Stress and Burnout in Ophthalmology Residents: a Pilot Study Jullia A. Rosdahl1, Karen Kingsolver2. 1Ophthalmology, Duke University, Durham, NC; 2Family Medicine, Duke University, Durham, NC. Purpose: Our hypothesis is that Mindfulness practice would decrease the stress and burnout in resident physicians. This pilot study was done to test this hypothesis in Ophthalmology residents and to inform the design of a larger study including residents in other specialties at our institution. Methods: Ophthalmology residents completed an optional and anonymous web-based survey before and after a Mindfulnessbased session, planned during a period thought to be stressful for the residents. The web-based survey included 3 validated survey instruments of stress and burnout: the Depression-Anxiety-Stress Scale (DASS-21), the Oldenburg Burnout Inventory (including Disengagement and Exhaustion subscales), and 10 questions from the Cognitive Failures Questionnaire. The Mindfulness-based session consisted of a 3-hour class introducing the concepts of Mindful Awareness, with practical exercises for nurturing resilience. The web-based survey was completed 1 week prior to the session, and 4-6 weeks after the session. Results: Sixty-six percent of the residents completed the initial survey (12 of 18 residents). 62% of the residents who participated in the Mindfulness-based session completed both the initial survey and the follow-up survey (5 of 8 residents). Baseline Stress scores and baseline Burnout Disengagement subscale scores were within the normal range; however, the residents had more symptoms of Exhaustion on the Burnout subscale (8 of 12 residents with scores > 2.25). Of the residents who completed the before and after surveys, 4 of 5 showed improvements in Stress and Burnout metrics. Conclusions: After a single Mindfulness-based session, Ophthalmology residents showed improvements in Stress and Burnout. Recommendations from the pilot study have been included in the on-going larger study, including shorter sessions (two 1-hour sessions instead of a single long session) and the use of paper-based surveys with protected time for completion to aid in study participation. Results from this pilot study support the use of Mindfulness-based techniques for decreasing stress and burnout as well as enhancing resilience in physicians. Commercial Relationships: Jullia A. Rosdahl, None; Karen Kingsolver, None Support: Arnold P. Gold Foundation (KK), NEI K12 grant EY016333-08 (JAR) Program Number: 5580 Poster Board Number: A0189 Presentation Time: 8:30 AM–10:15 AM Breaking Bad News: Evaluating the Impact of a Multidisciplinary Training Program for Ophthalmology Residents Sarah M. Hilkert1, 2, Shelly G. Jain1, Colleen M. Cebulla1, Sheryl A. Pfeil1, Susan C. Benes1, Janie Boyer1, Shira L. Robbins2. 1 Ophthalmology, Havener Eye Institute, the Ohio State University, Columbus, OH; 2Ophthalmology, Ratner Children’s Eye Center, University of California, San Diego, San Diego, CA. Purpose: Breaking bad news (BBN) is a common occurrence in medicine, and ophthalmologists are not exempt. To the best of our knowledge, there are no formal programs to train ophthalmologists ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts in this important task. We implemented a multidimensional training program to emphasize communication skills during difficult conversations with ophthalmology patients. The purpose of this study was to evaluate the impact of such formal training on BBN for ophthalmology residents. Methods: Residents at the Havener Eye Institute participated in a Grand Rounds series on BBN. This included a practice session delivering a difficult diagnosis to 3 standardized (actor) patients, a lecture on the SPIKES protocol for BBN, and a panel discussion with 3 real ophthalmology patient volunteers. To assess the efficacy of this program, residents were invited to complete anonymous, voluntary, IRB-approved surveys. After Grand Rounds, residents were asked to evaluate each aspect of the program using a 5-point Likert scale. Before and after training, residents were asked to report their current confidence level with respect to 12 different aspects of the bad news encounter, each derived from the original SPIKES protocol. Responses were compared using the matched-pairs ordinal test. The impact of this training program was evaluated by the overall rating of the program and by improvements in resident confidence. Results: Eleven ophthalmology residents completed the training. All 11 reported that they would use the SPIKES protocol in the future with ophthalmology patients. The mean Likert score for the overall program was 4.5. Most residents (67%) felt that the patient panel discussion was the most useful aspect of the program. Comparing matched surveys from before and after training, resident confidence in BBN increased significantly (P < 0.05) in 7 of the 12 measures. The most significant improvement was noted in the measure “setting realistic expectations without destroying hope” (p = 0.0095). Conclusions: Formal training can improve resident confidence; therefore, teaching communication skills for BBN should be integrated into ophthalmology residency education. As part of this training, the SPIKES protocol may serve as a useful template. Volunteer patients, who are willing to share their personal experiences, may offer valuable wisdom and insight into the bad news encounter. Commercial Relationships: Sarah M. Hilkert, None; Shelly G. Jain, None; Colleen M. Cebulla, None; Sheryl A. Pfeil, None; Susan C. Benes, None; Janie Boyer, None; Shira L. Robbins, None Support: This project has been supported in part by the Ohio Lions Eye Research Foundation - Grant K08EY022672, by the Clinical Skills Education and Assessment Center at the Ohio State University, and by P30EY022589 core grant funding at UC San Diego. Program Number: 5581 Poster Board Number: A0190 Presentation Time: 8:30 AM–10:15 AM Gender trends and practice differences of Canadian ophthalmologists Yvonne M. Buys1, Chryssa McAlister1, Yaping Jin1, 2, Rosa BragaMele1, Béatrice Des Marchais3. 1Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada; 2Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 3 Médecine-Dép. d, Université Lava, Quebec City, QC, Canada. Purpose: To describe the changing demographic of ophthalmologists in Canada and gender differences in practice patterns and lifestyle. Methods: The Canadian Institute for Health Information database was used to determine the yearly number, mean age and gender of licensed ophthalmologists and all other physicians in Canada from 1970-2011. A 48-item questionnaire was sent to Canadian ophthalmologists asking about practice patterns and lifestyle issues. Results were analyzed using χ2 and Fisher’s exact test where appropriate. Results: The ophthalmology workforce is aging from a mean age of 44.7 in 1970 to 53.1 in 2011. The proportion of female ophthalmologists has also increased from 3.1% in 1970 to 21.4% in 2011. Compared to all other physicians, ophthalmologists were significantly older by a mean of 2.4±0.9 years and the proportion of women was significantly less (36.8% for all other physicians in 2011) with the gender gap between ophthalmologists and all other physicians increasing from 4.8% in 1970 to 16.3% in 2011. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts 385 (102 female) ophthalmologists (30% response rate) completed the survey. 51% of women reported operating <2 days per month as compared to 36% of men (p=0.01) despite similar clinical hours. No statistically significant differences were found in other practice pattern parameters including laser refractive surgery, hospital affiliation, university appointment/rank and # of peer-review publications. 90% of males and 81% of females report having ≥1 child, but men report larger families (p<0.001). Women are commonly the primary caregivers while men report their partners as primary caregivers (p<0.001). Men report having part-time (41%) or unemployed partners (15%) who work in allied healthcare professions (p<0.001); women more commonly report full-time employed partners (72%) who are physicians or not in healthcare (p<0.001). 52% of women are unhappy with the amount of parental leave (p<0.001). 51% of women feel childbearing slowed or markedly slowed career progress, as compared to 15% of men (p<0.001). Conclusions: Ophthalmology workforce planning needs to consider the aging and feminization of the workforce since the way older physicians and female physicians practice will assume greater influence. The cause of differences in gender practice patterns, such as women reporting significantly less surgical time, needs to be explored to determine if this is due to barriers or choice. Commercial Relationships: Yvonne M. Buys, None; Chryssa McAlister, None; Yaping Jin, None; Rosa Braga-Mele, None; Béatrice Des Marchais, None Program Number: 5582 Poster Board Number: A0191 Presentation Time: 8:30 AM–10:15 AM A systematic review and cost-effectiveness analysis of disinfection methods for Goldmann Applanation Tonometry Omar Akhtar1, 2, Hargurinder Singh1, 2, William Hodge1, 2. 1 Ophthalmology, Western University, London, ON, Canada; 2 Epidemiology and Biostatistics, Western University, London, ON, Canada. Purpose: Goldmann applanation tonometry presents the problem of being one of the most widely used pieces of equipment in the ophthalmic clinic and a known risk factor for the transmission of epidemic keratoconjunctivitis. The purpose of the current review is to assess the effectiveness of three methods of disinfection – alcohol swabs, immersion in peroxide and the use of disposable prisms. An economic evaluation is undertaken to assess the cost-effectiveness of the three alternatives. In doing so, we contribute an evidence-based overview of the issue at an opportune time, as several jurisdictions are developing protocols regarding tonometer tip disinfection. Methods: A comprehensive literature review was undertaken with a librarian, comprising searches of 6 electronic databases and hand searches of the grey literature. A three-level screening process was undertaken by two reviewers according to pre-specified inclusion/ exclusion criteria. Values from included papers were used to inform a cost-effectiveness analysis undertaken using a decision tree model implemented in TreeAge. The analysis was undertaken from the hospital perspective and included all equipment and labour costs. Results: Synthesis of in vitro data indicates that all three are plausible methods of disinfection with a 64% reduction in log growth of EKC when peroxide is used compared to alcohol swabs. The ICERs from the cost-effectiveness analysis were $12,000/case averted using peroxide and $61,000/case averted with Tonosafe as compared to alcohol. Conclusions: Assuming clinical infection rates match in vitro disinfection data, the cost of bleach is high and the cost of Tonosafe is unacceptably high to reduce one potential case of adenoviral keratoconjunctivitis. Commercial Relationships: Omar Akhtar, None; Hargurinder Singh, None; William Hodge, None Support: AMOSO Innovation Fund (INN 12-010). Ontario, Canada; Ontario Graduate Scholarship, Canada Program Number: 5583 Poster Board Number: A0192 Presentation Time: 8:30 AM–10:15 AM Evaluating surgical efficiency in the transition from the Accurus to the Constellation Vision System for microincisional vitrectomy surgery (MIVS) from an operations management perspective Daniel Gologorsky1, Timothy G. Murray1, 2. 1Bascom Palmer Eye Institute, Miami, FL; 2Murray Ocular Oncology & Retina, Miami, FL. Purpose: This study compares surgical efficiencies, complications, and user perceptions associated with the transition from the Accurus to the next generation Constellation platform. The results are evaluated from an operations management framework. Methods: Electronic health records were obtained for all vitreoretinal surgical procedures at the Bascom Palmer Eye Institute during two discrete 12-month time periods, each reflecting dedicated usage of the Accurus and Constellation Vision systems. Data were limited to a single surgeon and evaluated on a number of metrics related to surgical efficiency. All records were evaluated for intraoperative complications. Results: Over a two-year study period, 514 eligible patients who underwent MIVS were identified: 281 with the Accurus and 233 with the Constellation. The transition in platforms was accompanied by statistically significant measures: an increase in the total number of patients operated on per day, a decrease in operating room time, and a decrease in MIVS procedure time. Combined MIVS/ phacoemulsification surgery saw similar declines in surgical room and procedure times. No increases in surgery-related complications were noted by quality assurance reviews. Conclusions: Statistically significant improvements were noted in three important measures of surgical efficiency: operative number of patients per day, operating room time, and surgical procedure time. These improvements reflect the positive impact of the combined and integrated, posterior and anterior, Constellation surgical platform. Hospital quality assurance review and surgeon evaluation of operative complications showed no increased safety or setup concerns during the transition. Operations management and queuing theory maintain that such an improvement in surgical capacity alone should lead to a valuable decrease in patient wait times. Revenues can be generated by increasing surgical volume, assuming the additional category of procedure yields a positive net present value. Increased revenues can be shunted toward alleviating bottlenecks in production by hiring staff or purchasing additional equipment. Ultimately, improved efficiency can be geared towards improving quality of care, decreasing costs, increasing revenues, improving employee conditions, or providing a valuable marketing opportunity. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Commercial Relationships: Alexander G. Miller, None; Llewelyn Rao, None; Douglas Y. Rowland, None; Joan Hornik, None Commercial Relationships: Daniel Gologorsky, None; Timothy G. Murray, None Program Number: 5584 Poster Board Number: A0193 Presentation Time: 8:30 AM–10:15 AM The Effect of Requiring Patient-specific Prescriptions on the Utilization of Intravitreal Bevacizumab Alexander G. Miller, Llewelyn Rao, Douglas Y. Rowland, Joan Hornik. Retina Associates of Cleveland, Beachwood, OH. Purpose: To evaluate the change in the use of bevacizumab (B) following the requirement for patient-specific prescriptions (PSP). Methods: We retrospectively analyzed the utilization of B, 0.5mg ranibizumab (R), 0.3mg ranibizumab (R-DME), and aflibercept (A) within a nine-member single retinal specialty practice over a threemonth period both before (May-July 2012 [pre-PSP]) and after (MayJuly 2013 [post-PSP]) the requirement of PSP for B by the Ohio Board of Pharmacy. Using a Likert Scale (LS) approach (strongly disagree to strongly agree), we surveyed all nine physicians in this group practice regarding three possible reasons (PSP, efficacy, safety) for the change in drug utilization. The relative proportions were calculated; the 95% confidence intervals for those estimates were calculated using the modified Wald method. The chi-squared test of proportions was used to compare frequencies in different years. P < 0.05 was taken as being statistically significant. Results: There was a significant decrease in the number of B injections (Inj), going from 2,752 (61.32% of pre-PSP Inj) to 1,503 (28.61% of post-PSP Inj), a change of 1,249 B injections (-29.35% as a percent of B total injections over both years). There was a significant increase in the number of R injections, going from 1,122 (25% of pre-PSP Inj) to 1,838 (34.99% of post-PSP Inj), a change of 716 R injections (24.19% as a percent of R total Inj over both years). There was a significant increase in the number of R-DME Inj, going from 0 (0% of pre-PSP Inj; R-DME became FDA-approved in August 2012) to 429 (4.40% of post-PSP Inj), a change of 429 R-DME Inj (100% as a percent of R-DME total Inj over both years). There was a significant increase in the number of A Inj, going from 614 (13.68% of pre-PSP Inj) to 1,483 (28.23% of post-PSP Inj), a change of 869 A Inj (41.44% as a percent of A total Inj over both years). The LS results showed the following responses for decreased B use: PSP (median category, 1st quartile, 3rd quartile [M, 1st, 3rd]: all strongly agree), safety (M, 1st, 3rd : strongly disagree, strongly disagree, disagree) and efficacy (M, 1st, 3rd: all disagree). Conclusions: There was significantly less B utilization year over year following the requirement for PSP of B. This change corresponded more with the notion of PSP requirement than either safety or efficacy concerns in this practice. Program Number: 5585 Poster Board Number: A0194 Presentation Time: 8:30 AM–10:15 AM Use of Statistical Analyses in the Ophthalmic Literature Renato Lisboa, Daniel Meira-Freitas, Andrew J. Tatham, Amir Marvasti, Lucie Sharpsten, Felipe A. Medeiros. Ophthalmology, Hamilton Glaucoma Center, La Jolla, CA. Purpose: To identify the most commonly used statistical analyses in the ophthalmic literature and to determine the likely gain in comprehension of the literature that readers could expect if they were to sequentially add knowledge of more advanced techniques to their statistical repertoire. Methods: All articles published from January 2012 to December 2012 on Ophthalmology, American Journal of Ophthalmology and Archives of Ophthalmology were reviewed. A total of 780 peerreviewed articles were included in this cross sectional study. Two reviewers examined each article and assigned categories to each one depending on the type of statistical analyses used. Discrepancies between reviewers were resolved by consensus. Total number and percentage of articles containing each category of statistical analysis were obtained. Additionally we estimated the accumulated number and percentage of articles that a reader would be expected to be able to interpret depending on their statistical repertoire. Results: Readers with little or no statistical knowledge would be expected to be able to interpret the statistical methods presented in only 20.8% of articles. In order to understand more than half (51.4%) of the articles published, readers were expected to be familiar with at least 15 different statistical methods. Knowledge of 21 categories of statistical methods was necessary to comprehend 70.9% of articles, while knowledge of more than 29 categories was necessary to comprehend more than 90% of articles. Retina and glaucoma showed a tendency for using more complex analysis when compared to cornea. Conclusions: Readers of clinical journals in ophthalmology need to have substantial knowledge of statistical methodology to understand all the results of published studies in the literature. The results of this study could provide guidance to direct the statistical learning of clinical ophthalmologists, researchers and educators involved in the design of courses for residents and medical students. Commercial Relationships: Renato Lisboa, None; Daniel MeiraFreitas, None; Andrew J. Tatham, None; Amir Marvasti, None; Lucie Sharpsten, None; Felipe A. Medeiros, Alcon (F), Allergan (F), Carl-Zeiss Meditec, Inc (F), Heildelberg Engineering, GmBH (F), Reichert (F), Topcon (F) Program Number: 5586 Poster Board Number: A0195 Presentation Time: 8:30 AM–10:15 AM Comparing Quality Performance Measures Publicly Reported by Ophthalmic Organizations Monica M. Michelotti1, Jennifer S. Weizer1, Joshua D. Stein1, Simon P. Kelly4, Declan W. Flanagan2, Anne C. Odergren3, Paul P. Lee1, Melanie Hingorani2. 1University of Michigan, Ann Arbor, MI; 2 Moorfields Eye Hospital, London, United Kingdom; 3St Erik’s Eye Institute, Stockholm, Sweden; 4Royal Bolton Hospital, Bolton, United Kingdom. Purpose: There is increasing global interest in evaluating health care quality by measuring clinical and patient-reported outcomes in all specialties and publishing these outcomes for the medical field and for the lay public. Several ophthalmic provider groups now publicly report performance, but the metrics used differ. Better understanding may advance work in improving the care of ophthalmic patients. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Methods: An online search for quality, especially outcomes, data for international ophthalmic institutions was performed; results were compared with published outcomes and performance data. The World Association of Eye Hospitals provided additional unpublished hospital-specific measures. Data were available from Aravind Eye Hospital, Cole Eye Institute, European Registry of Quality Outcomes for Cataract and Refractive Surgery, University of Michigan W.K. Kellogg Eye Center, Massachusetts Eye and Ear Infirmary, Moorfields Eye Hospital, Singapore National Eye Center, and St Erik’s Eye Hospital. Results: Multiple institutions reported similar complication rates for ophthalmic surgery. All measured wound infection rates and 30 day unplanned reoperation rates. Endophthalmitis rates after cataract surgery ranged from 0.00-0.09% (n=8). Most institutions reported either postoperative visual acuity (n=6) or difference in refraction from target after cataract surgery (n=4). The most commonly reported outcome was best-corrected visual acuity better than or equal to 20/40 (range 84-100%, n=3). Variance in reporting postoperative visual acuity outcomes occurred in the choice of measuring final or change in visual acuity, best- or uncorrected visual acuity, and timing of measurements. Eight institutions reported 22 cataract surgery outcomes and three reported rates for only uncomplicated patients. Subspecialty outcomes demonstrated similar trends. Differences in timing and exclusion criteria limited direct comparisons. Conclusions: Because published outcomes and quality of care data in ophthalmology varies by institution, understanding and identifying metrics that all might agree upon is crucial. Comparing outcomes by international ophthalmic institutions can provide insight for assessment for a broader and lay audience, helping ophthalmologists benchmark services in the timely quest for quality and safety. Commercial Relationships: Monica M. Michelotti, None; Jennifer S. Weizer, None; Joshua D. Stein, None; Simon P. Kelly, None; Declan W. Flanagan, None; Anne C. Odergren, None; Paul P. Lee, Board of Advisors of AAO Hoskins Center on Quality and Patient Safety. (S), University of Michigan, Chair (E); Melanie Hingorani, None Support: Michigan Ophthalmology Trainee Career Development Award Program Number: 5587 Poster Board Number: A0196 Presentation Time: 8:30 AM–10:15 AM Quality Measures Within a Group Retina Practice - Cultural Shift and Clinical Outcomes Brian Joondeph. Colorado Retina Associates, Denver, CO. Purpose: The purpose of this project is to demonstrate the feasibility of a group medical practice instituting several quality measures, both clinical and nonclinical. This involves not only the actual measures, but also the cultural shift within the practice, which supports quality measurement and improvement. Methods: Clinical data within an 11-physician retina-only practice was obtained over the year 2012 through the electronic medical record system. Specifically the one operation success rate for surgical repair of uncomplicated retinal detachment (RD) and macular hole (MH) were recorded, namely success 3 months following surgery. Nonclinical measures were based on two survey questions, measuring patient satisfaction with the practice and their individual physician, using a survey of 3% of patient visits for the year. Serious reportable events (SPE) for the year were collected, specifically intravitreal injections performed on the wrong eye or using the wrong medication. Results: Physicians within the practice showed little interest in the project but offered no resistance. The single operation success rates for repair of RD was 80% and for MH was 88%, with significant variation between physicians. Patient satisfaction scores noted 95% satisfaction with the practice and physicians. SPEs occurred with an incidence of 0.0125%. Fewer than half of the physicians wanted to know their surgical outcomes upon completion of the project. Conclusions: Quality can be measured within a group retina practice but the cultural shift toward systematic quality measurement remains challenging. Measures of quality and value are important new metrics under healthcare reform and such data may provide advantages to practices under new payment mechanisms. Ultimately it is better for medical practices to proactively measure quality than to allow the government or payers to perform these measures using arbitrary or flawed metrics. Commercial Relationships: Brian Joondeph, None Program Number: 5588 Poster Board Number: A0197 Presentation Time: 8:30 AM–10:15 AM Assessing the development of guidelines for primary open angle glaucoma using the AGREE II instrument Todd H. Driver1, Paul P. Lee2, Yvonne Ou3. 1Medical School, University of California, San Francisco, San Francisco, CA; 2 Department of Ophthalmology, University of Michigan Kellogg Eye Center, Ann Arbor, MI; 3Department of Ophthalmology, University of California, San Francisco, San Francisco, CA. Purpose: As guidelines become increasingly incorporated into clinical practice through “best practice” efforts and the adoption of electronic health records, understanding the methods used for their development may be helpful in assessing their utility. We previously evaluated primary open-angle glaucoma (POAG) guidelines with the AGREE instrument and found that there was opportunity to improve guideline development. We re-evaluated available national and supranational POAG guidelines to reflect changes in both the guideline evaluation instrument and the guidelines themselves. Methods: Four glaucoma fellowship-trained independent reviewers evaluated the current POAG guidelines published by the American Academy of Ophthalmology (AAO), South East Asia Glaucoma Interest Group (SEAGIG), European Glaucoma Society (EGS), and the UK National Institute for Health and Clinical Excellence (NICE) using the criteria prescribed by the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Both printed and online sources were included in the reviews. Results: Appraisal using the AGREE II instrument demonstrated that the AAO guideline scored favorably (>70%) in the domains of scope and purpose, rigor of development, clarity of presentation, applicability, and editorial independence, while no domain scored unfavorably (<50%). The SEAGIG guideline scored favorably in the scope and purpose domain, while scoring unfavorably in the domains of stakeholder involvement, rigor of development, applicability, and editorial independence. The EGS guideline scored favorably in the domains of clarity of presentation and applicability, while scoring unfavorably in the domains of scope and purpose, stakeholder involvement, and rigor of development. The NICE guideline scored favorably in all domains. Conclusions: The development of POAG guidelines has improved over time even while the requisite characteristics for desired development have been strengthened. Nevertheless, opportunities exist for guidelines to continue to better meet AGREE II recommended characteristics. Commercial Relationships: Todd H. Driver, None; Paul P. Lee, GlaxoSmithKline (I), Hoskins Center on Quality and Patient Safety of AAO (S), Merck (I), Pfizer (I); Yvonne Ou, None ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Program Number: 5589 Poster Board Number: A0198 Presentation Time: 8:30 AM–10:15 AM Time Motion Study of Electronic Health Record (EHR) Documentation Time in Ophthalmology Exams Michelle Hribar1, Sarah Read-Brown2, Maha Pasha1, 2, Leah Reznick2, Thomas Yackel1, Michael F. Chiang2, 1. 1Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR; 2Ophthalmology, Case Eye Institute, Oregon Health and Science University, Portland, OR. Purpose: Popular perception is EHR adoption in ophthalmology has resulted in increased time spent documenting during patient exams. Documentation time with EHR has been shown to be worse than with paper charts, with much of the documentation time occurring after the exam is completed [Chan et al, Am J Ophthalmol 2013], [Chiang et al, Trans Am Ophthalmol Soc 2013]. The purpose of this study is to measure the proportion of time spent using an EHR during a patient encounter using time-motion methods. Methods: We performed a time-motion study of patient exams in the Casey Eye Institute at Oregon Health & Science University. Using paper forms and time stamping software (Emerald Timestamp; Emerald Sequoia, Los Gatos, CA), data was collected by 2 observers who shadowed the ophthalmologist. We recorded the duration of time the ophthalmologist spent documenting in the EHR, talking, and examining the patient. If the ophthalmologist was multitasking and talking while either examining or documenting, this was recorded exclusively as examination or documentation time. Times spent doing each of the three activities was tabulated during each patient exam. Patient encounters were categorized for analysis as either “routine” or “complex” in the opinion of the ophthalmologist. An exam was considered complex if the diagnosis was difficult or if the patient was challenging (e.g. a crying infant). Results: Our observations represent 25 patient exams, on 4 days of clinic, from a single pediatric ophthalmologist. We found that the mean proportion of time spend documenting was 18% compared to 30% examining and talking 45% spend talking. This corresponded to mean ±SD times of 2.1 ± 1.1 minutes for documenting, 3.9 ± 2.7 minutes for examining, and 5.4 ± 2.3 minutes for talking (Table 1). Between routine vs. complex encounters, there were no statisticallysignificant differences in documentation or talking times between complex vs. routine exams (p = 0.1276, 0.2808 respectively), but there were nearly statistically-significant differences in times required for examining (p=0.0513). Conclusions: EHR documentation time occupies a significant proportion of ophthalmology patient encounters. Future EHR designs that streamline data entry will help reduce the amount of time spent documenting during ophthalmologic exam, and allow more time for examination and communication. Support: NLM Funding Grant 2 T15 LM 7088-21 and unrestricted departmental funding from Research to Prevent Blindness (New York, NY). Program Number: 5590 Poster Board Number: A0199 Presentation Time: 8:30 AM–10:15 AM Comparing iPhone and Android Smartphone Application Development in Ophthalmology Using the Ocular Trauma Score Application as a Prototype Emily Su1, Kateki Vinod1, Shiang Luong2, Omar B. Ozgur3, Paul Latkany1, Omar Ozgur1. 1Ophthalmology, The New York Eye and Ear Infirmary, New York, NY; 2University of California, Irvine, Irvine, CA; 3Irvine High School, Irvine, CA. Purpose: Apple® (iOS) and Android® (aOS) based smartphones are in use by 1.3 billion individuals at the start of 2014 and by 87% of physicians as part of their professional activity. In one quarter annum, 52.1% of US smartphone subscribers used aOS vs. 43.5% iOS. The number of total smartphone applications (apps) available on aOS and iOS are similar. Apps provide unique opportunities to optimize and predict outcomes of ophthalmology patients. Using a prototype application we built, the Ocular Trauma Score App (OTSA), we evaluate the ease of development, cost and time to distribution on both platforms. The Ocular Trauma Score (OTS) allows physicians to predict visual acuity outcomes based on initial exam parameters after eye trauma. Our OTSA provides a user-friendly interface to input data points based on exam findings in eye trauma patients in a template manner to calculate their OTS. Our null hypothesis is that there would not be identical development time between aOS and iOS for identical tasks. Methods: We measured the total time and cost for development and distribution of OTSA on iOS and aOS. We utilized an Agile Development Process for code development of identical deliverables on aOS and iOS. We masked hours utilized to the developers. Results: Although we found similar OTSA production time and effort on both iOS and aOS, distribution time and cost were different. For each sprint with an Agile Development Process, a time of 3-4 days was sufficient to complete code development for each platform. However, distribution cost required a yearly $99 USD developer fee for iOS, and only an initial $25 USD fee for aOS. OTSA also required a submission and approval process of 7-14 days for publication and updates on the iOS app store, but not for aOS. Functionality and usability were comparable between iOS and aOS. Conclusions: Using OTSA as an example, we demonstrate that app development requires customization for each platform, and less expense and distribution time for aOS. Given current trends suggesting similar market share between iOS and aOS in the US, development for both platforms is necessary for widespread distribution. The evolution of ophthalmic smartphone and tablet based apps must keep pace with the increasing use of these devices by ophthalmologists in patient evaluation and management. Commercial Relationships: Michelle Hribar, None; Sarah ReadBrown, None; Maha Pasha, None; Leah Reznick, None; Thomas Yackel, None; Michael F. Chiang, None ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Fig. 1 OTSA patient data input. Fig. 2 OTSA data score summary. Commercial Relationships: Emily Su, None; Kateki Vinod, None; Shiang Luong, None; Omar B. Ozgur, None; Paul Latkany, None; Omar Ozgur, None Program Number: 5591 Poster Board Number: A0200 Presentation Time: 8:30 AM–10:15 AM Feasibility of using OpenEyes to identify potentially eligible patients for clinical research Annelie Small, Bill Aylward, Ratna Khan, Carlos E. Pavesio, Maria Pefkianaki, Praveen J. Patel. NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom. Purpose: Identification of potentially eligible patients for clinical trials is vital for the success of undertaking clinical research and to ensure the widest possible access to new and advanced therapies through research. A new electronic patient record for ophthalmology (OpenEyes), which is modular and searchable has recently been developed and introduced at Moorfields Eye Hospital. One of the key strength of the software is in the clinical research arena where it can be used to identify patients who may be eligible for clinical trials therefore potentially reducing the time taken and resource deployed in meeting recruitment goals for clinical trials while also enabling the widest possible access of clinical trials to potentially eligible patients. Methods: In this feasibility analysis, we identified two clinical trials for the treatment of rare retinal conditions: one trial for patients with multifocal choroiditis and panuveitis patients and the other for patients with Behςet’s disease patients who are taking 20mg of Prednisolone orally. Secondly several search items mapped to the inclusion criteria of the trials were identified plus a time frame for the search period. OpenEyes was then used to search the ophthalmology patient record database for patients at Moorfields Eye Hospital who meet the search criteria. Finally, a sub-investigator applied the inclusion criteria and exclusion criteria from the clinical trial protocols to the electronic patient record to confirm potential eligibility. Results: A list of 58 patients for the Behςet’s disease trial [search time frame = 4 months] of which 5 are eligible for the trial and a list of 33 patients for the multifocal choroiditis trial [search time frame = 2 months] of which 1 is eligible for the trial was generated. The time spent on generating the lists was ≤ 3 minutes in total, including inputting search items and the system search. Conclusions: This confirms the feasibility of using OpenEyes successfully to identify patients who may be eligible for clinical trials. This novel, searchable system of the ophthalmology database has great potential to rapidly identify patients who may be eligible for clinical trials at Moorfields Eye Hospital thereby enabling more patients to access new therapies through clinical research while potentially reducing the time and resource needed to complete clinical trial recruitment. Commercial Relationships: Annelie Small, None; Bill Aylward, None; Ratna Khan, None; Carlos E. Pavesio, None; Maria Pefkianaki, None; Praveen J. Patel, None Support: The research was funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology Program Number: 5592 Poster Board Number: A0201 Presentation Time: 8:30 AM–10:15 AM Accuracy of the International Classification of Diseases, 9th Revision (ICD-9) as a research tool for the identification of patients with polymyalgia rheumatica and concurrent noninfectious uveitis Eduardo Uchiyama1, Sepideh Faez1, Humzah Nasir1, Sebastian H. Unizony2, George N. Papaliodis1, Lucia Sobrin1. 1Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; 2Rheumatology, Massachusetts General Hospital, Boston, MA. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Purpose: To report the accuracy of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in a hospital-based database for for identifying patients with polymyalgia rheumatica (PMR) and concurrent noninfectious uveitis. Methods: IRB approval for database queries and chart review was obtained. Multiple queries for patients with PMR (ICD-9-CM code 725.00) and all types of uveitis (anterior, intermediate, posterior, and panuveitis) were executed in the database of two large, general teaching hospitals using the Research Patient Data Registry (RPDR). Patients with infectious uveitis or other rheumatologic conditions were excluded. Patients who suffered from both PMR and concurrent ocular inflammatory disease were identified. The medical records of these patients were reviewed to confirm if the ICD-9 codes listed reflected the actual conditions described in the chart. Results: The RPDR query produced 10697 patients with the ICD-9 code for PMR and 4154 patients with ICD-9 codes for noninfectious uveitis. The number of patients with both PMR and noninfectious uveitis by ICD-9 codes was 66. Upon detailed review of medical records of these 66 patients, 31 actually had a clinical diagnosis of PMR, 37 actually had noninfectious uveitis, and only 19 had PMR with concurrent noninfectious uveitis. The patients who did not actually have the clinical diagnosis indicated by their ICD-9 code often had nonspecific joint pains or other causes of red eye instead of PMR and uveitis, respectively. Conclusions: While the use of ICD-9 codes has been validated for medical research of common diseases, our results suggest ICD-9 codes may be of limited value for epidemiological investigations of rarer diseases which can be more difficult to diagnose. The ICD-9 codes for two rarer diseases, PMR and uveitis, did not reflect the true clinical problem in a large proportion of patients in this study. Commercial Relationships: Eduardo Uchiyama, None; Sepideh Faez, None; Humzah Nasir, None; Sebastian H. Unizony, None; George N. Papaliodis, None; Lucia Sobrin, None Support: Massachusetts Lions Eye Research Fund Program Number: 5593 Poster Board Number: A0202 Presentation Time: 8:30 AM–10:15 AM Uses of the Word “Macula” in Written English, 1400-Present Stephen G. Schwartz1, Christopher T. Leffler2. 1Bascom Palmer Eye Institute, Univ of Miami Miller Sch of Med, Naples, FL; 2 Ophthalmology, Virginia Commonwealth University, Richmond, VA. Purpose: To review common uses of the word “macula” in written English from the early 1400s through the present day. Methods: The word “macula” was searched in multiple databases, including the Early English Books Online Text Creation Partnership, America’s Historical Newspapers, the Gale Cengage Eighteenth Century Collections, the Oxford English Dictionary, Google Scholar, and the Google n-grams database. Results: “Macula” has been used: as a non-medical “spot” or “stain”, literal or figurative, including in astronomy and in Shakespeare; as a medical skin lesion, occasionally with a following descriptive adjective, such as a color (macula alba, macula materna); as a corneal lesion, including the earliest identified use in English, circa 1400; and to describe the center of the retina. Francesco Buzzi (1751-1805) first described a yellow color in the posterior pole (“retina tinta di un color giallo”) in 1782, but did not use the word “macula”. “Macula lutea” was published by Samuel Thomas von Sömmering (17551830) by 1799, and subsequently used in 1818 by James Wardrop (1782-1869), which appears to be the first known use in English. The Google n-gram databse shows a marked increase in the frequencies of both “macula” and “macula lutea” following the introduction of the ophthalmoscope in 1850. Conclusions: “Macula” has been used in multiple contexts in written English, including many non-medical ones. Modern databases provide powerful tools to explore historical uses of this term, which may be underappreciated by contemporary ophthalmologists. Commercial Relationships: Stephen G. Schwartz, Alimera (C), Bausch + Lomb (C), Regeneron (R), Santen (C), ThromboGenics (R); Christopher T. Leffler, None Program Number: 5594 Poster Board Number: A0203 Presentation Time: 8:30 AM–10:15 AM Cost Effectiveness of Anti-Oxidant Vitamin + Zinc Treatment to Prevent the Progression of Intermediate Dry AMD to its Wet Form. A Singapore Perspective Shao Onn Yong1, Nakul Saxena2, Pradeep P. George2, Bee Hoon Heng2, Tock Han Lim1. 1Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore; 2Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore. Purpose: To determine if providing high dose anti-oxidant vitamins + Zinc treatment (AREDS formulation) to patients with intermediate Age Related Macular Degeneration (AMD) aged 40-79 years from Singapore is cost effective in preventing progression to Wet AMD. Methods: A hypothetical cohort of category 3 & 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: A) AREDS formulation OR placebo followed by Ranibizumab (as needed) for wet AMD B) AREDS formulation OR placebo followed by Bevacizumab (monthly) for wet AMD C) AREDS formulation OR placebo followed by Aflibercept (VIEW I and II trial treatment regimen) Costs were estimated for the above scenarios from the providers’ perspective and cost effectiveness was measured by cost per disability adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. Crude annual mortality rate was incorporated into the model. **Is this still applicable now that YLLs are no longer part of the analysis?** Results: Over 5,400 patients could be prevented from progressing to Wet AMD cumulatively over five years if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab or aflibercept was cost effective compared to either placeboranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$17,078.7 and SGD$14,299.8 respectively - well within the cost-effectiveness threshold). However, bevacizumab (monthly injections) alone was more cost effective compared to preventive anti-oxidant vitamins + Zn followed by bevacizumab. Cost savings as a result of prescribing AREDS formulation were SGD$46.7M and SGD$39.1M for ranibizumab and aflibercept arms respectively over 5 years. Conclusions: Prophylactic treatment with high dose anti-oxidant vitamins + Zn for intermediate AMD patients, followed by ranibizumab or aflibercept for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts DALYs associated with Wet AMD based on receipt or no receipt of AREDS formulation over 5 years. Cost per DALY averted based on possible treatment options for patients with Wet AMD Commercial Relationships: Shao Onn Yong, Novartis (C), Novartis (R); Nakul Saxena, None; Pradeep P. George, None; Bee Hoon Heng, None; Tock Han Lim, Novartis (C), Novartis (R) Program Number: 5595 Poster Board Number: A0204 Presentation Time: 8:30 AM–10:15 AM Cost-effectiveness Analysis of iStent and Phacoemulsification versus Glaucoma Medications in the Ontario Health Insurance Plan (OHIP) Yiannis Iordanous1, Cindy M. Hutnik1, Monali Malvankar1, 2. 1 Ophthalmology, University of Western Ontario, London, ON, Canada; 2Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada. Purpose: New minimally invasive glaucoma surgeries (MIGS) and devices are emerging to aid in lowering IOP and reduce patients’ reliance on topical medications. The iStent trabecular micro-bypass stent (Glaukos Corporation, Laguna Hills, CA) is an example of these MIGS devices; it has garnered much attention, as it is minimally invasive and effective in reducing patients’ dependence on glaucoma medications. It has data supporting its use as adjunctive therapy at the time of cataract surgery for patients who are on multiple glaucoma medications. However, a major challenge hindering adoption of these MIGS has been the perceived cost. With many health care systems evolving into cost-based models, analyses of cost, as well as efficacy and safety, are becoming increasingly important. The purpose of this study is to perform a cost effectiveness analysis comparing use of the iStent at the time of phacoemulsification versus the use of glaucoma medication within the Ontario Health Insurance Plan (OHIP). Methods: Primary economic analysis was performed by constructing a Makov model using TreeAge Pro 2013 to conduct cost-effectiveness analysis from the public third-party payer (Ontario Health Insurance Plan) perspective. Cost and effectiveness of three treatment strategies: medical therapy, cataract surgery and simultaneous iStent insertion, and cataract surgery only were compared over a 5-year period in managing patients with cataract and glaucoma whose intra-ocular pressures were not adequately controlled by two medications. In light of uncertainty of some parameters, we performed probabilistic sensitivity analysis to evaluate the robustness of the base-case results. Results: The primary outcome measure was quality adjusted life years (QALYs). The incremental cost-effectiveness of iStent at the time of cataract surgery over glaucoma medications only is $6824 per quality-adjusted life year. By comparison, the incremental costeffectiveness of cataract surgery only over glaucoma medications is $4179 per quality-adjusted life year. Conclusions: This analysis suggests that the use of iStent at the time of phacoemulsification is a cost-effective option for managing patients with mild to moderate open-angle glaucoma and cataract. These results, in conjunction with studies of efficacy and safety, may be useful in delineating the role of the iStent in our glaucoma treatment paradigm. Commercial Relationships: Yiannis Iordanous, None; Cindy M. Hutnik, None; Monali Malvankar, None Program Number: 5596 Poster Board Number: A0205 Presentation Time: 8:30 AM–10:15 AM Treatment Patterns and Associated Costs of Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration Szilard Kiss1, Pravin U. Dugel2, Kathleen Wilson3, Alice Huang3, David Smith3, Helen Varker3, Stephen S. Johnston3, Adam Turpcu4. 1 Ophthalmology, Weill Cornell Medical College, New York, NY; 2 Retina Consultants of Arizona, Phoenix, AZ; 3Truven Health Analytics, Bethesda, MD; 4Genentech, Inc., South San Francisco, CA. Purpose: Compare intravitreal (ITV) anti-VEGF injection totals and associated costs in patients who received aflibercept (AFB) or ranibizumab (RBZ) for neovascular age-related macular degeneration (AMD). Methods: Patients in this retrospective cohort study of US claims data received 1st- or 2nd-line ITV anti-VEGF treatment with RBZ or AFB (index date) from November 18, 2011–July 31, 2013 and were aged ≥18y on the index date with a ≥12 month baseline period of continuous insurance prior to this index date. AMD was diagnosed during the baseline period or on the index date (ICD-9CM 362.52), and patients had ≥6 or ≥12 mo of follow-up post index date with no switch of anti-VEGF therapy. Number of injections and their associated costs were assessed for 6- and 12-mo follow-ups. Multivariable regression comparisons for AFB vs RBZ were adjusted for baseline patient demographics, comorbidities, and general health status indices. Results: A total of 486 AFB patients and 1329 RBZ patients had ≥6-mo of follow-up data (134 and 571, respectively, in 12-mo analyses). Mean [SD] number of injections was similar at 12-mo for AFB and RBZ recipients for 1st-line therapy (5.4 [2.9] vs 5.7 [3.7], respectively) and 2nd-line therapy (6.4 [3.3] vs 6.3 [3.5], respectively; Figure). Mean [SD] anti-VEGF therapy-related costs were comparable in AFB and RBZ recipients at 6 mo ($7244 [$4208] ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts vs $7858 [$4805], respectively) and 12 mo ($11,046 [$6853] vs $11,417.81 [$8731], respectively). Multivariable regression showed that neither the number or costs of injections differed significantly between AFB and RBZ patients over the first 6- and 12-mo post index date (reference=RBZ: Incidence Rate Ratio [IRR]=0.97, 95% confidence interval [CI]=0.92-1.02, P=0.224 [6 mo]; IRR=0.93, 95%CI=0.82-1.05, P=0.224 [12 mo]; Cost Ratio [CR]=0.96, 95%CI=0.90-1.02, P=0.212 [6 mo]; CR=0.91, 95%CI=0.80-1.05, P=0.182 [12 mo]). Mean days between injections for AFB and RBZ differed by 2.9 days (44.8 and 41.9 days, respectively) for 1st-line patients and by 5.9 days (47.7 and 41.7 days, respectively) for 2nd-line patients. Conclusions: Injection frequency, days between injections, and costs did not differ significantly between AFB and RBZ over 6 and 12 mo in this claims analysis of AMD patients. Further follow-up is warranted; however, this initial analysis suggests AFB and RBZ treatment patterns and costs in AMD are similar in a real-world setting. Regeneron (C); Kathleen Wilson, Genentech, Inc. (C); Alice Huang, Genentech, Inc. (C); David Smith, Genentech, Inc. (C); Helen Varker, Genentech, Inc. (C); Stephen S. Johnston, Genentech, Inc (C); Adam Turpcu, Genentech, Inc. (E), Roche (I) Support: Genentech, Inc. Commercial Relationships: Szilard Kiss, Alcon (C), Alimera (C), Alimera (R), Allergan (C), Allergan (R), Genentech, Inc. (C), Genentech, Inc. (R), Optos (C), Optos (R), Regeneron (C), Regeneron (R); Pravin U. Dugel, Genentech, Inc. (C), Novartis (C), ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected].