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ARVO 2016 Annual Meeting Abstracts 479 Clinical potpourri Wednesday, May 04, 2016 3:45 PM–5:30 PM Exhibit/Poster Hall Poster Session Program #/Board # Range: 5536–5586/D0041–D0091 Organizing Section: Clinical/Epidemiologic Research Program Number: 5536 Poster Board Number: D0041 Presentation Time: 3:45 PM–5:30 PM Patient Utilization of Web-Based Health Data Management Technology in an Outpatient Ophthalmology Practice Setting Robert W. Wong1, 2, Mackenzie Franklin1, 3, Shelley Day1, 2, Jose A. Martinez1, 2, Clio A. Harper1, 2, James W. Dooner1, 2, Mark Levitan1, 2, Peter A. Nixon1, 2. 1Ophthalmology, Austin Retina Associates, Austin, TX; 2Surgery, Texas A&M Health Science Center, Bryan, TX; 3Molecular, Cellular and Developmental Biology | Neuroscience, Yale University, New Haven, CT. Purpose: In today’s evolving healthcare environment, technology has improved patient access to medical services from remote locations outside of the physician’s office. We performed a survey to assess our patients’ preferences and utilization patterns of web-based technology in managing their ocular disease. Methods: A fourteen question survey was conducted at a single, outpatient, private retina practice. The questions were designed to assess demographics, patients’ utilization of a smartphone, tablet, or personal computer (PC) to manage their personal health with regards to scheduling an appointment, pay medical bills, browse online physician reviews, or to research a medical condition within the past six months, patients’ interest in participating in telemedicine, using a wearable device, and using an at-home monitoring device for their ocular condition. Groups were compared across age (<35, 35 to 49, 50 to 64, and >65 years) and diagnosis. Results: 200 of 283 subjects completed the survey for a response rate of 71%. Age groups reflected those of a typical retina practice: Age <35 years (13.5%), age 35-49 (22.5%), age 50-64 (25.5%) and age >65 (38.5%). Younger patients use a smartphone, tablet or PC to manage or track their health (age <35, 74%; 35-49, 40%) more than older patients (age 50-64, 14%; >65, 12%). 77% of patients have either already used or were interested in using telemedicine in the future in lieu of a doctor’s visit to manage their healthcare. Nearly all younger patients (age <35, 93% and 35-49, 93%) and the majority of older patients (age 50-64, 66%; and >65, 56%) were interested in using a wearable device to monitor their health. Interest in using an at-home monitor device was fairly even across age groups (age <35, 74%; 35-49, 68%; 50-64, 56%; and >65, 62%). Of these, 100% of central serous retinopathy and 69% of macular degeneration patients expressed interest. Conclusions: The majority of younger patients, and some older patients, are currently using web-based technology to manage their health care and are interested in remote-based monitoring via telemedicine or wearable devices in the future. Most patients across all age groups expressed interest in using an at-home monitoring device with special concern for macular pathology where central vision is at risk. These findings may be helpful in guiding which services to offer patients in the future. Commercial Relationships: Robert W. Wong, None; Mackenzie Franklin, None; Shelley Day, None; Jose A. Martinez, None; Clio A. Harper, None; James W. Dooner, None; Mark Levitan, None; Peter A. Nixon Program Number: 5537 Poster Board Number: D0042 Presentation Time: 3:45 PM–5:30 PM Implementation and assessment of visual acuity screening of Ebola Virus Disease survivors utilizing the Peek Vision smartphone platform Sina Vahedi1, Allen O. Eghrari2, Rachel J. Bishop3, Christopher J. Brady2, Cavan S. Reilly4, Frederick L. Ferris3, Jemma Larbelee5, Mosoka Fallah6. 1Jefferson Medical College, Philadelphia, PA; 2Wilmer Eye Institute, Baltimore, MD; 3National Eye Institute, Bethesda, MD; 4University of Minnesota, Minneapolis, MN; 5Redemption Hospital, Liberian Ministry of Health, Monrovia, Liberia; 6PREVAIL III, Monrovia, Liberia. Purpose: Vision loss is a leading complaint among survivors of Ebola Virus Disease. Vision screening tools are needed that can be implemented in cross-cultural settings by technicians with minimal previous health care training. The PREVAIL III Ebola Survivor Study is a 5-year longitudinal study of the medical effects of Ebola Virus Disease (EVD) on survivors sponsored by the US National Institute for Allergy and Infectious Disease and the Liberian Ministry of Health and Social Welfare. We report the practical application of the smartphone-based Peek visual acuity assessment tool in Monteserrado County, Liberia among Ebola survivors and close contacts participating in the study. Methods: Non-ophthalmic health care workers were trained to use the Peek Vision Beta application, which presents the tumbling E in ETDRS character sizes. The Moto G smartphone, which contains a 4.5-inch screen and 1280 x 720 pixel resolution, was calibrated for use at 2.4 meters based on the visual angle of ETDRS character size. Visual acuity of each eye was independently tested using an occluder and results documented. 81.4% of survivors and 84.2% of controls failed visual acuity threshold of 20/25 or reported eye complaints and received a second, uncorrected distance visual acuity testing by an ophthalmic technician in a standardized examination lane using a tumbling E chart. Results were categorized as a binary outcome, either “good”(better than 20/40) or “not good” (20/40 or worse visual acuity). Results: Of 1092 total eyes examined by both eye technicians and health care workers, vision in was categorized as “not good” in 154 eyes (14.1%) by health care workers and in 103 eyes (9.4%) by eye technicians. Sensitivity for identification of “not good” vision was 73.7% and specificity for “good” vision was 92.1%. Conclusions: Health care workers without ophthalmic experience can perform smartphone visual acuity screening. Additional analyses will explore ideal screening cutoffs. These results are significant for capacity building in regions with limited ophthalmic personnel or facilities for both research and clinical care delivery. Commercial Relationships: Sina Vahedi; Allen O. Eghrari, None; Rachel J. Bishop, None; Christopher J. Brady, None; Cavan S. Reilly, None; Frederick L. Ferris, None; Jemma Larbelee, None; Mosoka Fallah, None Program Number: 5538 Poster Board Number: D0043 Presentation Time: 3:45 PM–5:30 PM Assessing the utility of phenylephrine 2.5% for diagnostic pupillary dilation James C. Liu1, 2, Wesley Green1, Susan M. Culican1, Gregory Van Stavern1. 1Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO; 2Indiana University School of Medicine Transitional Residency Program, Indianapolis, IN. Purpose: Phenylephrine eye drops are routinely used in dilated eye examinations, but have increased drastically in price over the past few years. We performed a prospective, unmasked, crossover These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts pilot study to evaluate whether the addition of phenylephrine to tropicamide produces any statistically and clinically significant change in pupil size. Methods: Twenty healthy students and faculty members affiliated with the Washington University School of Medicine were enrolled. Each had 3 distinct dilating eye drop regimens administered to the left eye on separate days. The routine regimen used clinically at Washington University for dilated eye examination is tropicamide (T) + proparacaine (PP) + phenylephrine (PE) (T+PP+PE). This was considered the standard therapy to which tropicamide + proparacaine (T+PP) and tropicamide alone (T alone) were compared. Measurements of pupil size were made before and 30 minutes after eye drop administration using an automated pupillometer. Primary outcome measures were post-dilation pupil size and proportion of pupils able to achieve post-dilation pupil size >7mm. The latter served as a measure of clinical significance. Comparisons between the 3 regimens were made using paired t-tests and McNemar’s test, with T+PP+PE serving as the standard therapy. Results: Mean post-dilation pupil size was 7.94±0.78mm, 7.64±0.78mm, and 7.48±0.77mm for T+PP+PE, T+PP, and T alone, respectively. T+PP+PE was statistically superior to T+PP (p=0.0043) and T alone (p<0.0001) with respect to post-dilation pupil size. The proportion of pupils able to achieve adequate pupil dilation of >7mm was 90%, 80%, and 70% for T+PP+PE, T+PP, and T alone, respectively. No statistical difference was observed in each regimen’s ability to achieve adequate pupil dilation of >7mm (T+PP+PE and T+PP: p=0.47; T+PP+PE and T alone: p=0.13). Conclusions: The addition of phenylephrine eye drops to tropicamide provides larger pupil dilation, but the magnitude of benefit is marginal and clinically insignificant in this healthy cohort. Commercial Relationships: James C. Liu, None; Wesley Green, None; Susan M. Culican, None; Gregory Van Stavern Support: This work was supported by awards to the Department of Ophthalmology and Visual Sciences at Washington University from a Research to Prevent Blindness, Inc. unrestricted grant, the NIH Vision Core Grant P30 EY 0268, and awards from the Lacy Glaucoma Research Fund to SMC. steroids, which are contraindicated in acute infectious conjunctivitis. Prescription fills differed by age, race, income & diagnosing provider (all p<0.001) but not contact lens wear (p=0.58) or HIV diagnosis (p=0.36) (Table 1). Whites, those with higher incomes, and more educated patients had higher odds of receiving antibiotics for acute conjunctivitis compared with non-whites, less affluent and educated patients (all p<0.0001) (Table 2). Compared to patients diagnosed by ophthalmologists (37% fill), patients had higher percentages & odds of antibiotic fill if diagnosed by urgent care MDs (68% fill; OR 3.02, CI 2.91-3.13), internists (58%; OR 2.64, CI 2.55-2.74), family practice MDs (55%; OR 2.31, CI 2.23-2.40), pediatricians (59%; OR 2.17, CI 2.03-2.32), and optometrists (45%; OR 1.19, CI 1.15-1.24). Patients with HIV were no more likely to receive antibiotics (p=0.81) and those with end-organ damage from diabetes were 18% less likely to get antibiotics (p<0.0001) compared to patients without these conditions. Conclusions: We identify rampant over-prescription of antibiotics for conjunctivitis in the US among insured patients, including potentially harmful practices that may increase costs, prolong infection duration, & lead to antibiotic resistance. Antibiotic use appears to be driven more by sociodemographic factors & provider type than medical indication. Program Number: 5539 Poster Board Number: D0044 Presentation Time: 3:45 PM–5:30 PM Substantial Over-Prescription of Antibiotics for Acute Conjunctivitis in the United States Nakul Shekhawat1, Roni M. Shtein1, Taylor Blachley1, Joshua D. Stein1, 2. 1W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI; 2Institute for Health Care Policy and Innovation, University of Michigan, Ann Arbor, MI. Purpose: Acute conjunctivitis is often caused by a virus, thus antibiotic therapy is usually unnecessary. We examined the extent that patients diagnosed with acute conjunctivitis are treated with topical antibiotics & factors associated with antibiotic use. Methods: We analyzed health claims data from a large US managed care plan from 2001-2014. Eligible patients were diagnosed with acute conjunctivitis & continuously enrolled for >90 days after initial diagnosis. We excluded hospitalized patients, those undergoing eye surgery, or those with chronic conjunctivitis. Topical antibiotic use was defined as a prescription fill within 14 days of initial conjunctivitis diagnosis. Patient demographics, diagnosing provider, time to prescription fill, & antibiotic class were studied. Multivariable logistic regression determined factors associated with antibiotic use. Results: Of 340,630 patients diagnosed with acute conjunctivitis, 198,511 (58%) filled prescriptions for topical antibiotics. 20% of patients (N=38,774) filled prescriptions for combined antibioticThese abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Commercial Relationships: Nakul Shekhawat, None; Roni M. Shtein, None; Taylor Blachley, None; Joshua D. Stein, None Support: Research to Prevent Blindness; Kellogg Foundation Program Number: 5540 Poster Board Number: D0045 Presentation Time: 3:45 PM–5:30 PM Sharp injuries in ophthalmology residency: results of a resident quality improvement project Aliya Z. Jiwani, Jo Anne Ricca, Carolyn Kloek. Ophthalmology, Mass. Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Purpose: While sharp injuries may occur more frequently in residents1-3 than other health care workers, few studies in the US examine sharp injuries in residents1-5 and none specifically examine ophthalmology residents. The purpose of this research is to characterize sharp injuries among ophthalmology residents at a high volume academic center with a high number of resident procedures. Methods: A retrospective chart review was conducted of the 27 ophthalmology resident sharp incident reports filed at Massachusetts Eye and Ear Infirmary’s (MEEI) occupational health from 2009-2014. An anonymous survey was administered to the 24 current MEEI ophthalmology residents in June 2015. Results: The 27 sharp injuries reported to occupational health by ophthalmology residents occurred more frequently to PGY-2s, during oculoplastics procedures and with suture needles. The source patient’s blood was drawn 89% (24/27) of the time, and 12.5% (3/24) of the source patient’s blood was positive. For the anonymous survey, 83% (20/24) responded. Of the respondents, 45% (9/20) self-reported at least one sharp stick during ophthalmology residency, but 2 of these residents failed to report the injuries. The majority (71%, 5/7) of those who reported the stick felt the reporting process was very easy to reasonable, with 29% (2/7) reporting that it was cumbersome. 70% of respondents knew how to report a sharp injury at the primary teaching site, but only 10-20% knew how to do so at the other 7 sites. Qualitative comments were collected about factors contributing to the injury and reasons for non-reporting. Conclusions: Education in sharp safety to decrease injuries and improve reporting rates may be helpful. Commercial Relationships: Aliya Z. Jiwani, None; Jo Anne Ricca, None; Carolyn Kloek, None Program Number: 5541 Poster Board Number: D0046 Presentation Time: 3:45 PM–5:30 PM Triaging Ophthalmic Emergencies: A 4-Parameter Tool embedded in an Emergency Department’s Electronic Health Record System Farhan Merali1, Oliver Schein1, Stephanie Figueroa2, Peter Pronovost3, Mustapha Saheed2, Rose Johnson2, Tina Tolson2, Peter Hill2, Michael P. Grant4, Shameema Sikder1. 1Cornea and External Disease, Wilmer Eye Institute, Baltimore, MD; 2Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD; 3 Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Baltimore, MD; 4Ophthalmic Plastic and Reconstructive Surgery, Wilmer Eye Institute, Baltimore, MD. Purpose: To assess the reliability of a 4-parameter triaging system embedded in the electronic health record (EHR) system in predicting ophthalmic urgency when conducted by emergency department (ED) nurses. Methods: A 4-parameter triaging system previously found to be highly reliable in detecting urgent ophthalmic pathology at an ophthalmic ED was adapted for use by non-ophthalmic providers: (1) Descriptive and visual guidelines for use were developed, and (2) The triaging system and developed guidelines were embedded into the ED’s EHR. All patients presenting to the ED with an ophthalmic complaint were assigned a score between 0 and 12 by an ED triaging nurse that assessed the patient’s presentation in four categories: eye redness, eye pain, risk of open globe, and vision loss. Color coding was assigned based on the cumulative triaging score: 0–3 was classified as green, 4–7 as yellow, and 8–12 as red. The triaging score was compared against the ophthalmic consultant’s assessment in the same categories and assigned diagnosis. Results: During the study period, 250 patients were assessed. Of these, 72 (28.8%) patient presentations were classified as urgent (a code of yellow or red), with the remainder classified as non-urgent. Patients were triaged using the tool within 9.1 ± 5.3 minutes of arriving at the ED. The sensitivity of the system was 0.958(95% CI 0.88-0.99) and specificity 0.781(95% CI 0.71-0.84). The correlation between urgency level as coded by triage nurses and eye care providers was significant with a Spearman’s rank coefficient 0.67 (P<0.0001): 82.0% patients were coded at the identical level of urgency by both providers; 6.0% were undercoded by one category level, 11.6% were overcoded by one category level, and 0.4% were overcoded by two category levels. Conclusions: The triaging tool as administered by ED nurses using the guidelines developed is a simple, rapid and highly sensitive method of detecting urgent ocular pathology. Such a system holds the potential to decrease the cost of eye care to patients and the health care system more broadly. By reliably referring patients with non-urgent ocular conditions to outpatient appointments in collaboration with ophthalmic providers, wait times and length of stay may be considerably reduced for all-comers, while valuable and costly ED resources would be conserved for patients with truly urgent conditions. Commercial Relationships: Farhan Merali, None; Oliver Schein, None; Stephanie Figueroa, None; Peter Pronovost, None; Mustapha Saheed, None; Rose Johnson, None; Tina Tolson, None; Peter Hill, None; Michael P. Grant, None; Shameema Sikder, None Program Number: 5542 Poster Board Number: D0047 Presentation Time: 3:45 PM–5:30 PM Emergency Department Patient Experience of Eye Care: Implications for First Year Ophthalmology Residents Jenna Kim, Syed A. Hussnain, Ninani Kombo. Ophthalmology and Visual Sciences, Yale University, New Haven, CT. Purpose: Little is known about the level of patient satisfaction from those who receive care from first year ophthalmology residents, particularly in the Emergency Department (ED) setting. We hypothesize that despite acuity of problems and the time constraints placed by the nature of care in the ED, first year ophthalmology residents provide satisfactory patient care with high level of empathy, professionalism, and clinical competency. Methods: Thirty-one consecutive patients presenting for follow-up at our acute eye care clinic after initial ED encounter were requested to fill out an anonymous survey on a voluntary basis. The inclusion criteria was age greater than 18, competency in English language, initial evaluation by a first year ophthalmology resident in ED and subsequent discharge (i.e. no admission to the hospital), and absence of altered mental status at the time of ED encounter. Providers were blinded to patients’ participation and responses. Results: Of the 31 survey responders, 20 were male (mean age 43 years, range 18-75 years). Over 50% presented to the ED with an acute injury to the eye. Ninety percent of the patients rated the importance of hand hygiene as “very” or “extremely important”, and 84% remembered the resident practicing hand hygiene, and 16% did not remember whether hand hygiene was practiced. All survey These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts participants reported that the provider spoke clearly, which was rated “very” or “extremely important” by 93% of the participants. Level of clinical knowledge was cited by 21 out of 31 responders as the most important criteria when evaluating their provider. The overall satisfaction score (possible score range between 0-10) was 9.4 ±1.02. High education level was the greatest predictor for lower level of satisfaction with the encounter (LR 5.75) compared to those with fewer than 4 years of college education. Conclusions: Our survey suggests that despite the obstacles in providing optimal patient care due to the time constraints in the ED and the relatively limited clinical experience of the first year ophthalmology residents, high level of patient satisfaction can be achieved by adhering to principles of patient-centered care such as clear communication and hand hygiene. As level of knowledge was perceived as the most important factor by patients in this survey, beginning residents should not ignore the value of enhancing their knowledge depth and breadth. Commercial Relationships: Jenna Kim; Syed A. Hussnain, None; Ninani Kombo, None Program Number: 5543 Poster Board Number: D0048 Presentation Time: 3:45 PM–5:30 PM Internal Medicine Residents and the Fundus: Improving skill with direct ophthalmoscopes and increasing knowledge of basic ocular pathology Christine Martinez, Cheryl Bloomfield. Internal Medicine, Lehigh Valley Health Network, Breinigsville, PA. Purpose: Following graduation from medical school, internal medicine physicians-in-training receive very little instruction on use of the direct ophthalmoscope and basic eye pathology. We surveyed residents to determine comfort level and skill with the direct ophthalmic exam, implemented a structured didactic curriculum and then re-surveyed the same residents. We hypothesize that appropriate and focused education will result in resident-reported improvement in comfort, skill, and knowledge. Methods: Sixty-one internal medicine residents were administered a 10-question survey to determine comfort and skill level with the direct ophthalmoscope, frequency of attempted and successful fundus exams, and knowledge of basic ocular pathology. Five structured didactic sessions were then planned and implemented by a program faculty member and optometrist. These teaching sessions included material presented in a lecture format as well as hands-on exam practice. Following the conclusion of the sessions residents were resurveyed to assess for improvement in comfort level, exam skills and knowledge of eye pathology. Results: The response rate of the initial survey was 51% (31/61). 77% (24/31) of residents reported that they are either “very” uncomfortable or “somewhat” uncomfortable with the direct ophthalmoscope. 90% (28/31) attempt a fundus exam on half or less than half of patients in whom an eye exam with a direct ophthalmoscope is clinically indicated. 26% (8/31) of residents are “never” or “rarely” able to visualize blood vessels on retinal exam and 74% (23/31) are “never” or “rarely” able to visualize the optic nerve. 65% (20/31) of residents answered a basic knowledge question regarding the visualization of the optic nerve incorrectly. The results of the repeat survey are still pending at the time of abstract submission. Conclusions: Our study demonstrates that internal medicine residents report significant discomfort and difficulty with the direct ophthalmoscope exam. A deficiency in ocular knowledge is also revealed. Residents will likely report improvement in comfort, skill, and knowledge following the implementation of a focused didactic program. Commercial Relationships: Christine Martinez, None; Cheryl Bloomfield, None Program Number: 5544 Poster Board Number: D0049 Presentation Time: 3:45 PM–5:30 PM The profile of respondents to a survey of ophthalmologists in the English-speaking Caribbean: principal findings Andrew F. Smith1, 2, Alex Klotz1, Juan Carlos Silva3, Nigel Barker4. 1 Medmetrics Inc., Ottawa, ON, Canada; 2Department of Ophthalmology, King’s College London, London, United Kingdom; 3Pan American Health Organization, Bogota, Colombia; 4 Ophthalmological Society of the West Indies, St. Michael, Barbados. Purpose: There is no data on the profile of ophthalmologists providing ophthalmological services and treatments across the English-speaking Caribbean. We aimed to gather such data, as it is potentially useful for planning the delivery of eye care services and training initiatives across the region. Methods: As no comprehensive database of ophthalmologists working in the English-speaking Caribbean could be located, both national and regional ophthalmological societies across the English-speaking Caribbean were contacted to extract a listing of ophthalmologists likely to be involved in the provision of ophthalmological services and treatments. A total of 171 practicing ophthalmologists and/or ophthalmology residents were identified and contacted via email and telephone across 12 English-speaking Caribbean nations in late 2014 and early 2015. Results: A total of 49 completed questionnaires were returned, yielding a response rate of 29%. Survey respondents, reported working 42.71 hours per week, with 60%, 38% and 2% of these hours spent in the private, public and NGO sectors, respectively. Among those ophthalmologist’s returning completed questionnaires, 70% percent had completed their ophthalmology training outside of the Caribbean, and 40% had obtained some form of sub-specialty qualification. Overall, the average length of the residency training for responding ophthalmologists was 48.5 months with a range from between 36 and 60 months. The average length of tenure as a practicing ophthalmologist among respondents was 15.27 years and only 8% indicated that they would retire in the next 5 years. Most of the small numbers of responding ophthalmologists reported they had good access to key the pieces of ophthalmological equipment needed for diagnosing, treating and conducting eye surgery. Conclusions: Given the small number of respondents to the survey, the findings from this survey do not represent the entire ophthalmological community in the English speaking Caribbean. Strategies to increase the coverage of data collection on the ophthalmological workforce across the region warrant urgent attention in assessing the human resources development needs in ophthalmology. Commercial Relationships: Andrew F. Smith, MedMetrics Inc (C), MedMetrics Inc (F), MedMetrics Inc; Alex Klotz, MedMetrics Inc. (C), MedMetrics Inc (F); Juan Carlos Silva, Pan American Health Organization; Nigel Barker, None Support: Pan-American Health Organization (PAHO) Program Number: 5545 Poster Board Number: D0050 Presentation Time: 3:45 PM–5:30 PM Influence of Post-interview Communication Between Residency Applicants and Ophthalmology Residency Programs on Programs’ Ranking of Applicants Nicholas Behunin, Ingrid U. Scott, Mark Goerlitz-Jessen, Darren Hill. Ophthalmology, Penn State Hershey, Hummelstown, PA. Purpose: While San Francisco Match rules permit postinterview communication (PIC) between residency applicants These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts and ophthalmology residency programs, it is unknown whether PIC affects programs’ ranking of applicants. The current study investigates the influence of PIC between residency applicants and ophthalmology residency programs on programs’ ranking of applicants. Methods: An anonymous survey including multiple choice and Likert-type questions was created using RedCAP electronic data capture tools hosted at Penn State Hershey. An e-mail with a description of the study and link to the survey was sent to the program director (PD) of each ophthalmology residency training program in the United States accredited by the Accreditation Council for Graduate Medical Education (ACGME). Weekly reminders were sent for two consecutive weeks. Results: Thirty-three of 116 (28.4%) PDs completed the survey. The type of PIC followed by the proportion of respondents who reported that type of PIC would typically result in an applicant being moved upward (more favorably) on the program’s rank list included: applicant stating they will rank the program highly (3.0%), applicant stating they will rank the program “number 1” (3.0%), applicant’s faculty mentor (NOT personally known to PD) stating the candidate will rank program “number 1” (0.0%), applicant’s faculty mentor (personally known to PD) stating the candidate will rank program “number 1” (21.2%), applicant’s faculty mentor (NOT personally known to PD) endorsing candidate as outstanding (15.2%), applicant’s faculty mentor (personally known to PD) endorsing candidate as outstanding (42.4%). Among respondents, 39.4% agreed they would not consider changing applicant rank order as a result of any PIC from an applicant or their faculty mentor(s), and 6.0% agreed that applicants who did NOT have a faculty mentor contact the program on their behalf were disadvantaged compared to those who contacted programs. Conclusions: Post-interview endorsement by a faculty mentor who is personally known to an ophthalmology residency PD is more likely to improve the rank of an applicant than any other type of PIC included in the study. This suggests that applicants who do not engage in PIC or who do not have “well-connected” mentors may be at a disadvantage. Further study is warranted to investigate these findings further. Commercial Relationships: Nicholas Behunin, None; Ingrid U. Scott, None; Mark Goerlitz-Jessen, None; Darren Hill, None Program Number: 5546 Poster Board Number: D0051 Presentation Time: 3:45 PM–5:30 PM The experiences and perceptions of paediatric ophthalmic clinicians using electronic medical records in the United Kingdom Maria S. Cross1, George W. Aylward3, Jugnoo S. Rahi1, 2. 1UCL Institute Child Health, London, United Kingdom; 2National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; 3UCL Institute of Ophthalmology, London, United Kingdom. Purpose: Electronic medical records (EMRs) are at the core of a recent movement towards information-driven healthcare. However, paucity in the evidence base surrounding EMR adoption, use and evaluation within paediatric ophthalmology hinders technological development and meaningful application within the field. We conducted a national survey to investigate paediatric ophthalmic clinicians’ experiences and perceptions surrounding routine EMR use in the United Kingdom (UK). Methods: A survey was designed with four sections that considered (1) routine documentation practices, (2) the perceived benefits of routine EMR use, (3) the perceived barriers, and (4) optional questions assessing experiences of routine EMR use. The survey was administered online. Email invitations were sent to potential participants via the national mailing list for paediatric ophthalmologists, with two reminder emails sent three weeks apart. Responses were collected between June and August 2015, and analysed using univariate statistical tests. Results: 90 individuals from 42 different UK hospitals completed the survey. Only 16.9% of respondents routinely use electronic documentation methods, although 64.4% reported some experience using an EMR. Respondents’ perceptions varied according to these experiences. Individuals with any prior experience (N=58) were significantly more like to identify ‘difficult-to-navigate system designs’ (p=0.013) and ‘poor user interface’ (p=0.015) as barriers or challenges preventing routine EMR use. However in both groups, ‘software functionalities not meeting clinical needs’ was most frequently identified as the biggest barrier preventing use (25.3% of all individuals). Conclusions: This survey suggests UK paediatric ophthalmic clinicians do not believe EMRs meet clinical demands. The increased likelihood of those with prior EMR experience to select certain usability-related barriers indicates system usability is a bona fide challenge faced when adopting these systems. These findings highlight the need to fully understand the specific clinical requirements and limitations of EMR users during system design, procurement and implementation, to produce both a useful and usable information system. Commercial Relationships: Maria S. Cross, None; George W. Aylward, None; Jugnoo S. Rahi, None Support: Ulverscroft Vision Research Group (UVRG), National Institute for Health Research (NIHR) Great Ormond Street Biomedical Research Centre Program Number: 5547 Poster Board Number: D0052 Presentation Time: 3:45 PM–5:30 PM Accuracy of Internet Image Search of fundus pathology as a learning tool in ophthalmology David Xu, Shawn R. Lin, Pradeep S. Prasad. Jules Stein Eye Institute, Los Angeles, CA. Purpose: Image and pattern recognition is key to clinical competence in ophthalmology. Internet Image Search, notably Google Image Search (GIS) in the U.S., has become an important teaching tool for ophthalmology trainees and allied health staff. Users utilize search results to enhance their own foundry of reference images for each disease. However, Google results are presented by a search-rank algorithm which does not take into account the accuracy of the image to what was searched. We quantify the accuracy of results and assess the quality of the image source in several fundus pathologies. Methods: Ten common and 10 uncommon fundus pathologies were randomly selected from an ophthalmic text. GIS was performed and the top 10 consecutive results were analyzed. Results were graded as having adequate (> 300 pixel resolution) or poor image quality, correct diagnosis, peer-reviewed source, brief, comprehensive or no supporting text, and correct supporting text. Correctness of diagnosis was evaluated by review of the image and context in the supporting text. The image source was classified as originating from professional ophthalmic education, professional medical education, general health information, ophthalmic health information, private practice, ophthalmic retail, medical association, peer-reviewed journal, book or private websites. Results: In total, 200 images and source websites were evaluated in the study. The majority were of adequate quality (74%). Most images were fundus photographs (80%) and a minority contained These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts multiple image modalities (30%). Overall, 7.5% were of the incorrect diagnosis. Among common pathologies, 1% were of the incorrect diagnosis while 14% of uncommon pathologies were incorrect. Half (51%) of the top image results were from professional ophthalmic education websites. 30% of images were from peer-reviewed sources. About one third (30%) of websites had only brief descriptions of the pathology while 20% had no supporting text. 10% of images were published on private websites created by non-experts. Ten websites contributed 46% of all resulted images. Images of the incorrect diagnosis were presented most often due to mis-attribution to part of the search phrase (e.g. drusen in “dominant drusen”). Conclusions: Internet Image Search rapidly generates a collection ophthalmic pathology for study. Attention should be paid to the accuracy of images originating from a myriad of sources. Commercial Relationships: David Xu, None; Shawn R. Lin, None; Pradeep S. Prasad, None Program Number: 5548 Poster Board Number: D0053 Presentation Time: 3:45 PM–5:30 PM Ophthalmology in the Emergency Department: A survey of Emergency Medicine Residents Andrew Parlin1, Josh Oliver2, Walter Steigleman1, Michael D. April2. 1 Ophthalmology, Brooke Army Medical Center, San Antonio, TX; 2 Emergency Medicine Department, Brooke Army Medical Center, San Antonio, TX. Purpose: The purpose of the study is to assess San Antonio Military Medical Center (SAMMC) Emergency Medicine (EM) residents’ understanding of ophthalmology/ophthalmic emergencies. After graduating, most new Emergency Physicians will be practicing without the benefit of ophthalmology residents or support immediately available for consultation. This will be true in both small community military and civilian hospitals, and even more relevant while providing care in an austere deployed environment. This is especially true when considering the military’s rules for taking care of civilian patients in a deployed setting. These rules are referred to as medical rules of engagement (MEDROE) and limit care to civilians with threat to life, limb, or eyesight. This study could be used to assess if more ophthalmologic education/training needs to be instituted at SAMMC and other EM programs, as well as gauge progress within the residency Methods: EM residents will undergo a test approved by the Ophthalmology department twice during the year—at both the beginning and ending of the academic year, to gauge progress of ophthalmic knowledge. Only second year residents have the opportunity to rotate within the ophthalmology department and the rotation is limited to two weeks. Testing biannually can provide objective data regarding the efficacy of this rotation, as well as the routine teaching that occurs within the emergency department. In addition to the test, residents will also fill out a survey containing a self-assessment of ophthalmic knowledge and exams skills/abilities, to include individual comfort in managing ophthalmic emergencies after graduation. During our first phase of data collection 31 residents completed the test and survey. We are expecting similar numbers at the end of the academic year. Results: After the second round of testing, the data will be analyzed, and a comparison made between the different residency years, and between those who have and have not rotated through the ophthalmology department at SAMMC. Conclusions: To be determined Commercial Relationships: Andrew Parlin, None; Josh Oliver, None; Walter Steigleman, None; Michael D. April Program Number: 5549 Poster Board Number: D0054 Presentation Time: 3:45 PM–5:30 PM Patient Satisfaction in Emergency Eye Care: Yelp Reviews as a first look Benjamin Jastrzembski1, 2. 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; 2Department of Ophthalmology, Harvard Medial School, Boston, MA. Purpose: Patient satisfaction is a growing priority in the context of pay for performance reimbursement, but the determinants of patient satisfaction in the setting of emergency eye care are poorly characterized. In this retrospective study, public, online Yelp reviews (www.yelp.com) of 4 dedicated eye emergency departments in the U.S. were examined to identify factors affecting patient satisfaction. Methods: All online Yelp reviews discussing eye emergency departments at 4 U.S. hospitals were included in the study. Each review rated overall experience on a scale from 1 (low) to 5 (high) stars and included an unstructured, free-form comment. Freeform comments were categorized as discussing one or more of the following themes: visit time, cost & insurance, medical knowledge & competence, physician & staff interpersonal skills, and care provided by residents / trainees. Results: Thirty-three online Yelp reviews from 4 eye emergency departments were included in the analysis. The average numerical rating was 2.9 stars with a standard deviation of 1.7 stars. The most common theme discussed in free-form comments was visit time (79% of reviews). Twelve of the 13 one-star reviews discussed visit time in the free-form comment. The least common theme discussed was cost & insurance (12% of reviews) and care by residents / trainees (18% of reviews). Only 1 of the 13 one-star reviews discussed care being provided by a resident / trainee. There was no statistically significant difference in star rating between reviews that discussed care being provided by residents / trainees and those that did not (p=0.678). Conclusions: Online reviews of 4 dedicated eye emergency departments suggest mixed patient satisfaction overall. The high number of reviews discussing visit times indicates this is a key determinant of patient satisfaction. There was no evidence to suggest that care by residents / trainees, who typically provide the majority of care in emergency eye settings, had a positive or negative effect on patient satisfaction. The Center for Medicare and Medicaid Services (CMS) is currently developing the Emergency Department Patient Experiences with Care (EDPEC) survey, which will further elucidate factors affecting patient satisfaction in EDs. The EDPEC survey will also facilitate comparison between multiple EDs and pay for performance reimbursement. Commercial Relationships: Benjamin Jastrzembski, None These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Program Number: 5550 Poster Board Number: D0055 Presentation Time: 3:45 PM–5:30 PM Evaluation of the efficacy of the nurse triage at the ophthalmic emergencies of the Jules Gonin Ophthalmic Hospital (HOJG), Lausanne, Switzerland Aurelie Pison1, Ciara Bergin2, Christina Gianniou2, Aurélie Martin2, Alejandra Daruich1, 3, Yan Guex-Crosier2, Jean-Louis Bourges1, 3, Francine Behar-Cohen2, 4. 1Ophthalmology, Groupe Hospitalier Cochin-Hôtel-Dieu, Paris, France; 2Jules Gonin Ophthalmic Hospital, Lausanne, Switzerland; 3Université Paris Descartes, Paris, France; 4 Centre de recherche des Cordeliers, Université Paris Descartes, Paris, France. Purpose: The urgency of an ophthalmic condition determines the delay and the means undertaken to its management. Very few nurse triage systems have been developed in the field of ophthalmology. A local nurse triage system has been developed at the ophthalmic emergency room of the Jules Gonin Ophthalmic Hospital (HOJG). The purpose of the study was to determine the efficacy of this triage system. Methods: This retrospective study included 1133 consecutive patients that showed up at the emergency room of the HOJG, Lausanne, Switzerland from the 17th november 2014 to the 19th december 2014. The patients were evaluated by the nurse using a questionnaire to classify patients into four degrees of emergency (white, yellow, violet, and red : increasing degree of urgency) according to the symptomatology described by the patient. The patients were then examined by the doctor, who evaluated also the degree of emergency (according to a scale). The arrival time of the patient, the time of the nurse triage, and the time of examination by the doctor were also recorded. Results: 1269 patients were recruted in one month, and 1133 finally included in the analysis. 64% of the patients were evaluated as « violet » according to the nurses (725/1133). 43% of the patients were evaluated as « white » according to the doctors (485/1133). There had been an agreement between the nurse and the doctor for 23% of the patients (261/1133). 76% of the patients (857/1133) had been overvalued during the nurse triage.1% of the patients (15/1133) had been undervalued by the nurse triage. Among those 15 patients, ten were evaluated as « red » by the doctor. The mean waiting time for the patients evaluated as « red » by the nurse was 60 minutes; for the « violet » patients it was 93 minutes; for the « yellow » patients 102 minutes; and for the « white » patients, 291 minutes. The distribution of the waiting time during the day showed an increase in the waiting times for patients who arrived at lunch hours (between noon and 2pm). Conclusions: This nurse triage system showed overvaluation for 76% of the patients, underevaluation for 1% but 67% of those undervalued patients were evaluated as « red » by the doctor. A new optimized system is presented and discussed. Commercial Relationships: Aurelie Pison, None; Ciara Bergin, None; Christina Gianniou; Aurélie Martin, None; Alejandra Daruich, None; Yan Guex-Crosier, None; Jean-Louis Bourges, None; Francine Behar-Cohen, None Program Number: 5551 Poster Board Number: D0056 Presentation Time: 3:45 PM–5:30 PM Community emergency department referral patterns, diagnostic accuracy, and initial management of patients referred to a tertiary emergency eye care department Alia Durrani, Murtaza K. Adam, Charles M. Calvo, Ann P. Murchison. Ophthalmology, Wills Eye Hospital, Philadelphia, PA. Purpose: Dedicated eye emergency departments remain a rare resource in the United States. Availability of ophthalmologic consults for emergency eye care remains a commodity in most community emergency departments. Our dedicated eye emergency department (EED) is located in an urban location, allowing for a large catchment area and referral variety. We performed a prospective, cross-sectional study to examine the referral patterns, initial management, and diagnostic accuracy of referrals to a dedicated eye care emergency department from community providers. Methods: A telephone survey via a transcribed referral line was conducted of referring providers between November 2014 and January 2015. Collected clinical and demographic data was compared to EED documentation. Referrals were excluded from analysis if an attending EED ophthalmologist did not complete a clinical examination. Statistical analysis was performed with SPSS V22.0. Diagnostic agreement between EED physicians and referring providers (MD, RN, NP, PA) was calculated collectively and separately. Results: Sixty-five referrals were included in our study; 39 of these were from emergency departments and urgent care providers with the remainder from office-based eye care personnel. Overall diagnostic agreement between EED ophthalmologists (OMDs) and referring emergency providers was 27.5%, whereas diagnostic agreement between EED OMDs and eye care personnel was 58.3%. There was a significant difference in visual acuity obtained by referring emergency providers and the EED. Forty-nine percent of referring emergency providers noted availability of on-call OMDs available for consultation, with no patient evaluated by an on-call OMD prior to transfer. Thirty-nine percent of referrals from emergency providers required urgent ophthalmic care. Conclusions: The proportion of urgent referrals from referring emergency providers highlights the need for access to ophthalmic providers in community settings. Methods to improve on-site ophthalmic care in the community could include increased availability of eye care providers and tele-ophthalmology. The role of mid-level providers in addition to ongoing ophthalmic education for emergency providers should be explored. Commercial Relationships: Alia Durrani, None; Murtaza K. Adam, None; Charles M. Calvo, None; Ann P. Murchison, None Program Number: 5552 Poster Board Number: D0057 Presentation Time: 3:45 PM–5:30 PM Enhancement of Clinical and Research Activity with a Novel Electronic Medical Record System Lorenzo Iuliano1, Rosangela Lattanzio1, Giuseppe Querques1, Maurizio Battaglia Parodi1, Saretta Patrih2, Mauro Campigotto2, Nicola Baratella2, Alessandro Meo2, Cesare Tanassi2, Francesco Bandello1. 1Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; 2NIDEK Technologies Srl, Albignasego, Italy. Purpose: Electronic Medical Records (EMRs) are known to be useful tools in the daily clinical practice, but integration with the research activity is critical. We performed a retrospective observational study to evaluate the advantages of employment of a novel ophthalmological EMR platform (NIDEK nLIFE), customized for research purposes. Methods: nLIFE system is designed to manage any subtype of ophthalmological visit, tailored to the qualification of logging-in user. The software entirely runs on a web-based interface and is customized depending on the ophthalmologist subspecialty. nLIFE is equipped with a built-in alert system that warns for the potential patient eligibility in a specific trial. It also includes a structured- These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts language field for diagnosis and treatment history classification, designed to ease the retrospective research of patients and/or diseases with specific characteristics of interest. We analyzed the time to fulfill the target patient number of a sample of 10 research protocols that started 1 year before (June 2013-May 2014) and 10 protocols (matched for similar eligibility criteria) that started 1 year after nLIFE employment (June 2014-May 2015). Furthermore we calculated the proportion of studies that achieved the target number in the first 60 days. We also made a research simulation of candidate patients for all new protocols that are about to start in our clinic. Results: Average time for completing the target patient number significantly reduced from 84±21 days to 49±12 days after nLIFE employment (p<0.0001). The proportion of studies that reached the target patient number in the first 60 days was superior in the postnLIFE period (7 out of 10) compared to the pre-nLIFE period (2 out of 10) (p<0.0349). The research simulation of candidate patients with protocol-specific enrolment criteria exceeded the required target number for any tested protocol. Exceeding patient rate ranged from a minimum of 31% to a maximum of 119% (average 52%). Conclusions: Despite general ophthalmological EMRs are commercially available since different years, the interconnection between clinical and research activity is critical. nLIFE system is a novel EMR platform customized on the ophthalmologist subspecialty that, beyond showing an effortless capacity to share data with other interfaces, demonstrated to be a useful and manageable tool for an integrated clinical and research workflow. Commercial Relationships: Lorenzo Iuliano, None; Rosangela Lattanzio, None; Giuseppe Querques, Novartis (C), Heidelberg (C), Allergan (C), Alimera sciences (C), Bayer schering pharma (C), Bausch and Lomb (C), Zeiss (C); Maurizio Battaglia Parodi, None; Saretta Patrih, NIDEK Technologies Srl (C), NIDEK Technologies Srl; Mauro Campigotto, NIDEK Technologies Srl, NIDEK Technologies Srl (C); Nicola Baratella, NIDEK Technologies Srl (C), NIDEK Technologies Srl; Alessandro Meo, NIDEK Technologies Srl (C), NIDEK Technologies Srl; Cesare Tanassi, NIDEK Technologies Srl, NIDEK Technologies Srl (C); Francesco Bandello, Farmila Thea (C), Sanofi-Aventis (C), Bayer (C), Hoffmann-La Roche (C), Thrombogenics (C), Alcon (C), Novartis (C), Bausch and Lomb (C), Pfizer (C), Allergan (C), Genentech (C), Novagali Pharma (C), Alimera (C) Program Number: 5553 Poster Board Number: D0058 Presentation Time: 3:45 PM–5:30 PM Review of Malpractice Litigation in Glaucoma over the Decades Christopher Shah1, Stephanie B. Engelhard1, Austin Sim1, Ashvini Reddy2. 1University of Virginia, Charlottesville, VA; 2 Ophthalmology, Wilmer Eye Institute, Baltimore, MD. Purpose: To report the allegations, outcomes, and monetary awards of medical malpractice lawsuits in glaucoma to inform clinical decision-making and guide risk management. Methods: Retrospective review of malpractice verdicts, rulings, and settlements related to ophthalmology in the United States WestLaw database from 1930-2014. Data including subspecialty focus of glaucoma, year filed, state, patient gender, legal allegation, nature of injury, verdicts, indemnities, and (when applicable) financial award were collected and analyzed. To enable meaningful comparison, monetary awards were adjusted to 2015 United States dollars. Results: A total of 1083 malpractice cases against ophthalmologists were identified, and 68 (6.3%) of these had subspecialty focus in glaucoma. These were subdivided into non-interventional (n = 49) and surgical/procedural (n = 19). Overall, 67.6% of outcomes favored the physician, defendants. Of the 24 outcomes favoring the plaintiff, monetary awards were reported for 19 cases with a mean award of $256,556.60 (range: $150,000 to $3,000,000) at time of filing. This was adjusted to $342,297.20 (range: $589,891.09 to $3,020,022.30) for value in 2015. The most common reason for litigation of those with payout was failure to diagnose/treat (n= 12), followed by surgical complication (n = 4) and adverse effect of medication (n = 3). See Figure 1 for number of cases by decade and Figure 2 for number of cases by State. Conclusions: Glaucoma represents a small percentage of malpractice litigation within ophthalmology and, historically, most outcomes favor the defendant. Outcomes favoring the plaintiff were associated with failure to diagnose/treat rather than from surgical or procedural interventions. Figure 2: Number of Malpractice Cases in Glaucoma by State. No cases found for states not represented in the figure. Commercial Relationships: Christopher Shah; Stephanie B. Engelhard, None; Austin Sim, None; Ashvini Reddy, None Program Number: 5554 Poster Board Number: D0059 Presentation Time: 3:45 PM–5:30 PM Ophthalmology malpractice litigation in pediatric patients Stephanie B. Engelhard1, Christopher Shah1, Austin Sim1, 2, Ashvini Reddy3. 1Ophthalmology and Visual Sciences, University of Virginia, Charlottesville, VA; 2School of Law, University of Virginia, Charlottesville, VA; 3Wilmer Eye Institute Johns Hopkins University, Baltimore, MD. Purpose: To report and analyze the causes and outcomes of ophthalmology medical malpractice litigation involving patients under age 18. Methods: The WestLaw® database was reviewed for all lawsuits including settlements and trial verdicts related to ophthalmology in These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts the United States from 1930-2014. All cases in which plaintiffs were under 18 years of age at time of inciting event were included in the analysis. Pediatric cases were compared to adult cases in the database. Results: Sixty-eight ophthalmology malpractice cases involving plaintiffs under the age of 18 were included in the study. Thirty-six cases (52.9%) resolved via jury trial. Defense verdicts were issued in 19 (52.8%) pediatric cases compared to 418 (71.0%) adult cases (P=0.021). Seventeen cases (47.2%) resulted in plaintiff verdicts, with a mean jury award of $4,815,692.67 (median, $883,280.97; range, $147,765.38-$42,061,689.81). Nine cases (13.2%) resulted in settlement, with mean adjusted indemnities of $1,912,737.79 (median, $1,377,688.84; range, $92,070.38-$8,493,086.24). The remaining 23 cases (33.8%) involved appellate rulings, post-trail relief rulings, and one bench verdict. Jury awards (P=0.002) and indemnity payments (P=0.003) were significantly higher in pediatric cases than in adult cases. Legal blindness cases were more likely to result in plaintiff verdicts (P=0.210). Common clinical scenarios in cases of litigation were traumatic ocular injury (22.1%), retinopathy of prematurity (ROP) (17.6%), and endophthalmitis (8.8%). Conclusions: Cases involving pediatric patients were significantly more likely to be resolved in favor of the plaintiff and to have higher monetary value than adult cases. ROP cases resulted in the highest payments to plaintiffs, and cases involving legal blindness and/or endophthalmitis were more likely to be resolved in favor of the plaintiff. Commercial Relationships: Stephanie B. Engelhard, None; Christopher Shah, None; Austin Sim, None; Ashvini Reddy, None Program Number: 5555 Poster Board Number: D0060 Presentation Time: 3:45 PM–5:30 PM Comparing the Psychometric Properties of the Original and Short Versions of the Glaucoma Treatment Compliance Assessment Tool Gordon T. Barker, Steven L. Mansberger. Devers Eye Institute, Portland, OR. Purpose: To compare the psychometric properties of a reduced (22 statements) to a long version (47 statements) of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), which is based on the organizational structure of the Health Belief Model. Methods: We created a reduced GTCAT by removing statements that: 1) did not appear in either the final Principal Components Analysis (PCA) model and 2) did not have a univariate association with adherence; or 3) were highly correlated with a correlation coefficient of .60 or higher with one another. To verify we did not remove key statements, we used PCA on the 25 removed or remaining statements to verify a stable organizational structure and used univariate analysis to determine if we removed a potentially predictive statement. Last, we assessed the construct validity of the remaining statements using PCA and assessed their predictive validity using univariate and multivariate analysis. Results: Of the original 47 GTCAT statements, we removed 22 because they did not appear in either the PCA analysis or the univariate regression analysis. We removed an additional 3 statements due to high intercorrelation (r = .76-.80). PCA of the 25 excluded statements resulted in no components extracted, and univariate regression indicated no predictive statements. As a whole the removed statements were not predictive (R2=.035, p = .26) of adherence. Clinical acumen suggested re-inclusion of 4 statements with alternate wording. PCA of the remaining 22 items resulted in the extraction of 5 components (knowledge, susceptibility, cues to action, self-efficacy, barriers). Multiple regression showed 6 statements associated with higher adherence (adjusted R2 = 0.27, p<.001), and as a whole the GTCAT-S predicted adherence (R2= .167, p = .01). Conclusions: A reduced GTCAT maintained an organizational structure consistent with the Health Belief Model and high predictive ability. Future glaucoma medication adherence studies can use the reduced model to determine whether a change in health behavior as measured by the GTCAT is associated with a change in adherence. Commercial Relationships: Gordon T. Barker, None; Steven L. Mansberger, None Program Number: 5556 Poster Board Number: D0061 Presentation Time: 3:45 PM–5:30 PM Identification and Recognition of Limitations of Retrospective Studies in Select Peer-reviewed Journal Pooja Mehta, Neil M. Bressler. Retina, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD. Purpose: Since retrospective designs can introduce bias or confounding on results, and as such, should be noted by authors. This study aimed to determine how often clinical research publications in select ophthalmology journals that are retrospective in design state “retrospective” design in the title or methods, and how often limitations of that design are mentioned or commented upon in the discussion section. Methods: Original investigations from three ophthalmology journals with relatively high impact factors as well as a similar specialty journal in otolaryngology and a subspecialty journal in retina were reviewed in 2004 to 2005 and in 2014 to 2015. All original investigations, excluding brief reports; case series; case reports; or observations, were reviewed to determine if the study design was retrospective. Retrospective designs were defined as studies performed after the outcomes of interest had already occurred; most commonly case control studies, but also retrospective cohort or case series. Results: Journals reviewed included the American Journal of Ophthalmology, JAMA Ophthalmology, JAMA Otolaryngology, Ophthalmology, and RETINA. Preliminary results suggest that fewer than one-third of all of the articles mentioned in the Discussion section that the retrospective design was a limitation to the interpretation of the results in 2004 to 2005; this increased relatively by 50% to 100% by 2014 to 2015. However, in fewer than 5% of the discussions did the authors mention how the retrospective design might affect the interpretation of the results both last decade and this decade. Conclusions: Over the past decade, authors in the journals evaluated are more likely to indicate that a retrospective study has limitations that can affect the interpretation of the results, but few authors indicate exactly how those limitations might affect the interpretation of the results. Commercial Relationships: Pooja Mehta, None; Neil M. Bressler, None Support: Unrestricted grants to Retina Division - Johns Hopkins University School of Medicine Program Number: 5557 Poster Board Number: D0062 Presentation Time: 3:45 PM–5:30 PM The fate of research abstracts presented at the ARVO Annual Meeting Edoardo Villani1, Filippo Tresca Carducci2, Stela Vujosevic3, Paolo Nucci1. 1Department of Clinical Sciences and Community Health, University of Milan. San Giuseppe Hospital., Milan, Italy; 2 Istituto Clinico San Siro, Milan, Italy; 3University of Padova, Padova, Italy. These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Purpose: To evaluate the publication rate of research abstracts presented at the ARVO Annual Meeting and to assess influencing factors. Methods: We randomly selected and reviewed 20% of all accepted abstracts, presented as either oral or poster presentations, at the 2010 ARVO Annual Meeting. A Pubmed-Medline search was performed to identify a matching journal article. Two- and 5-year publication, impact factor of publication (Journal Citation Reports® published by Thomson Reuters), sub-specialty (Scientific Sections), area of origin, and presentation type were tabulated. Results: We selected 1238 abstracts, 1097 (88.5%) presented as poster and 142 (11.5%) presented as oral papers. The most represented Scientific Sections were Retina-RE (n=212; 17.1%), Cornea-CO (n=176; 14.2%), and Glaucoma-GL (n=149; 12%). The less represented was Anatomy and Pathology/Oncology-AP (n=43; 3.5%). The most represented areas of origin were North America (n=702; 56.7%), Europe (n=284; 22.9%), and Asia (n=158; 12.8%). The overall 5-year publication rate was 51.7% (n=641), significantly higher for papers than for posters (66.2% vs 50%; P<0.001, Fisher’s exact test). The overall 2-year publication rate was 36% (n=446), significantly higher for papers than for posters (47.2% vs 34.5%; P<0.01). Chi-Square test showed significant different publication rates among the Scientific Sections (P<0.001): >60% for Physiology/ Pharmacology-PH, Retinal Cell Biology-RC and Visual Neuroscience-VN; <50% for Eye Movements/Strabismus/ Amblyopia/Neuro-ophthalmology-EY, RE, and Visual Psychophysics/Physiological Optics-VI; 50-60% for all the other Sections. No significant different publication rates were found among the areas of origin (51%-58%), except South America (37%) and Africa (25%). The mean impact factor of journals where the abstracts were published was 3.4±2.7 (range 0-33.6), significantly higher for oral papers than for posters (4.6±4.1 vs 3.2±2.3; P<0.001, T-test), significantly higher for VN (5.9±7.8) compared to the other Sections (P<0.001, ANOVA and Tukey post hoc test), and significantly lower for South America compared to North America and Europe (P<0.05). Conclusions: The ARVO Annual Meeting is a largely interdisciplinary platform for exchanges of ideas and information for a large number of researchers all over the world. The differences in publication rate between posters and papers and among Sections should be kept in mind when interpreting the presented results. Commercial Relationships: Edoardo Villani, None; Filippo Tresca Carducci, None; Stela Vujosevic, None; Paolo Nucci, None Program Number: 5558 Poster Board Number: D0063 Presentation Time: 3:45 PM–5:30 PM Female Authorship in Major Academic Ophthalmology Journals: trends in recent years Michael Mimouni1, Ori Segal2, Shiri Zayit-Soudry1, Arie Y. Nemet2, Yoreh Barak1, Noa Geffen2. 1Ophthalmology, Rambam Health Care Campus, Atlit, Israel; 2Ophthalmology, Meir Medical Center, Kfar Sava, Israel. Purpose: Despite an improvement in the disparities between men and women, a significant gap between genders exists in many fields of scientific research. The purpose of this study was to evaluate trends in the prevalence of female authorship in Ophthalmology over recent years. Methods: Using the PubMed Search engine, we conducted an observational study of trends in gender distribution of all authors in 6 Ophthalmology journals between January 2002 and December 2014. Journals were chosen based on published impact factors. The full names and the positions (first, middle or last) of all authors in every article were collected. A Google based name identifier was used to determine the gender of authors based on their first names. Names identified with a probability of 3 to 1 and greater were included in final analyses. Results: A total of 102,254 authors from 23,026 published articles were included. There was a significant rise in the percentage of female authors over time with a steeper slope for first authors than for last (p<0.001) though in 2014 female authors were still below the 50% mark in all categories of authorship. The rise in the percentage of female authorship was similar in basic and clinical research but was steeper for first authorship than for last authorship (p<0.001). In all three authorship positions, female contribution was consistently higher in basic research publications. The rise in the percentage of female authorship was significantly steeper for general journals than for subspecialty journals (p<0.001). There was no significant rise over the years for last authorship in subspecialty journals. In all three authorship positions female contribution was consistently higher in general ophthalmology journals than for subspecialty journals. In multivariate analysis, subspecialty journals and last author position were significantly predictive of male gender while advancing publication year and first author position were significantly predictive of female gender (p<0.001). Conclusions: Despite an overall increase in the contribution of women to the field of Ophthalmology, a gap still exists between the frequency of women in roles of clinical-practice and that in roles of scientific leadership. In particular, female contribution to papers published in subspecialty Ophthalmology journals, and the proportion of women listed as last authors on overall Ophthalmology publications, are still low. Commercial Relationships: Michael Mimouni, None; Ori Segal, None; Shiri Zayit-Soudry, None; Arie Y. Nemet, None; Yoreh Barak, None; Noa Geffen, None Program Number: 5559 Poster Board Number: D0064 Presentation Time: 3:45 PM–5:30 PM Tele-ophthalmology for age related macular degeneration and diabetic retinopathy: A systematic review and meta analysis Karim F. Damji, Atsushi Kawaguchi, Noha Sharafeldin, Aishwarya Sundaram, Sandra Campbell, Christopher Rudnisky, Ezekiel Weis, Matthew Tennant. University of Alberta, Edmonton, AB, Canada. Purpose: Recent technological advances combined with the projected rise in chronic eye disease and shortage of ophthalmologists have led to an increased interest in tele-ophthalmology. We conducted an up-to-date systematic review to evaluate the clinical effectiveness of tele-ophthalmology as an alternative to face-to-face patient screening and management for three major chronic eye diseases: agerelated macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma. Methods: A search was executed by an expert librarian of the following databases: MEDLINE, EMBASE, EBM Reviews including Cochrane Databases using controlled vocabulary and key words representing “telehealth” and “ophthalmology”. We included English language, randomized controlled trials (RCTs) published after 2000 for the analysis. Two reviewers independently assessed quality and extracted data. We used the standard methods of The Cochrane Collaboration to assess methodological quality and risk of bias. For all included trials, bias due to participant knowledge of the allocated intervention was categorized as high risk; however, given the characteristics of the tele-ophthalmology intervention, we assume participant blinding was not feasible. Results: The search results identified 2,239 unique records and after screening 6 reports of 4 RCTs met the inclusion criteria: 2 trials on These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts AMD and 2 trials on DR. No RCTs were found on glaucoma. Four different outcomes were analyzed: visual outcome, participation in the screening program, referral accuracy, and waiting time to receive referral. Three trials compared detection of choroidal neovascularization (CNV) (n=2146, Odds Ratio (OR): 1.55, 95% Confidence Interval (CI): 1.11 to 2.17). One trial compared teleophthalmology using a home monitoring device to standard selfreporting of changes in visual acuity (n=1520, OR: 1.74, 95%CI: 1.09 to 2.76). Two trials on diabetic retinopathy screening reported on participation in the screening program (n=626, OR: 12.99, 95%CI: 7.90 to 21.33). Conclusions: The review provides evidence of clinical benefits for detection of neovascular AMD and DR screening using teleophthalmology. It also demonstrates feasibility of carrying out randomized trials of tele-ophthalmology, albeit with differing modalities for tele-screening. Further research is needed specifically to study clinical effectiveness for glaucoma. Commercial Relationships: Karim F. Damji; Atsushi Kawaguchi, None; Noha Sharafeldin, None; Aishwarya Sundaram, None; Sandra Campbell, None; Christopher Rudnisky, None; Ezekiel Weis, None; Matthew Tennant, None Program Number: 5560 Poster Board Number: D0065 Presentation Time: 3:45 PM–5:30 PM Risk Indicators and Prevalence of Undetected Eye Disease in Chinese Americans: The Chinese American Eye Study (CHES) Roberta McKean-Cowdin1, Rohit Varma2, Mina Torres2, Charlotte E. Joslin3, Chunyi Hsu2, Xuejuan Jiang2. 1Preventive Medicine, Univ of Southern California, Los Angeles, CA; 2 Ophthalmology, USC Eye Institute, Los Angeles, CA; 3 Ophthalmology and Visual Science, Illinois Eye and Ear Infirmary, Chicago, IL. Purpose: To characterize the level of undetected eye disease (UED) in Chinese Americans 50 years of age and older, and the proportion of UED attributable to uncorrected refractive error (URE) and specific types of eye disease. Methods: A population-based study of adults participating in the Chinese American Eye Study was completed. Data were obtained by clinical examination and participants were defined as having eye disease if diagnosed at the clinic with macular degeneration, glaucoma, diabetic retinopathy, cataract, or refractive error. Participants diagnosed with incident eye disease at the clinic visit and not reporting a past history were considered undetected. URE was These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts defined as an improvement of 2+ lines in visual acuity in the better seeing eye after refraction. Odds ratios and 95% confidence intervals (95%CI) were calculated to evaluate potential associations between demographics, clinical characteristics, or lifestyle factors and UDE. Results: Of the 2,284 cases of eye disease in CHES, 1,077 (47.2%) were undetected prior to completing the CHES clinical examination. Of these, 668 (29.3% of 2,284) had URE, and 331 (14.5% of 2,284) had URE alone (without any known ocular diseases). Of the 1,077 with UDE, 197 (18.3% of 1077) were visually impaired based on presenting visual acuity (VA), while only 57 (5.3% of 1077) were visually impaired based on best corrected VA. The major types of undetected eye disease included 281 (12.3% of 2,284) of macular degeneration, 255 (11.2%) glaucoma/ocular hypertension, 193 (8.5%) diabetic retinopathy, and 67 (2.9%) cataract. The major predictors of UDE included male sex, older age, a history of diabetes, not speaking English, never having a regular physical exams, not having a regular place of medical care, low income, not having other comorbidities, and never having a complete eye exam. Conclusions: While Chinese Americans are typically not recognized as a racial group in the United States negatively impacted by health disparities or experiencing limited access to health care, we found that a high proportion of Chinese Americans in our population-based sample had UED. Outreach and education to the Chinese American community on the value of regular eye exams is needed. Proper refraction and early detection of disease and treatment can improve vision of older, Chinese Americans. Commercial Relationships: Roberta McKean-Cowdin; Rohit Varma, None; Mina Torres, None; Charlotte E. Joslin, None; Chunyi Hsu, None; Xuejuan Jiang, None Support: grants EY-017337 from the National Eye Institute, National Institute of Health, Bethesda, Maryland and an unrestricted Departmental grant from Research to Prevent Blindness, New York, NY 10022 Program Number: 5561 Poster Board Number: D0066 Presentation Time: 3:45 PM–5:30 PM Ophthalmic Screening Patterns Among Youth with Type 1 and Type 2 Diabetes Enrolled in a Large U.S. Managed Care Network Sophia Wang1, Chris A. Andrews1, Thomas W. Gardner1, Michael Wood2, Kanakadurga Singer2, Joshua D. Stein1, 3. 1 Ophthalmology, University of Michigan, Ann Arbor, MI; 2Pediatric Endocrinology, University of Michigan, Ann Arbor, MI; 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. Purpose: The American Academy of Ophthalmology recommends that ophthalmic screening for diabetic retinopathy (DR) occur by 5 years after initial diabetes mellitus (DM) diagnosis among youth with Type 1 DM (T1DM); the American Diabetes Association recommends that youth with Type 2 DM (T2DM) be screened at the time of initial DM diagnosis. It is unknown to what extent youth with DM obtain eye examinations in accordance with these guidelines. We investigated the rate of screening for DR and its associated factors in a large cohort of youth with T1DM and T2DM in a nationwide U.S. managed care network. Methods: We reviewed health care claims database records to identify all youth age ≤21 years who were newly diagnosed with DM from 2001 to 2014. A previously validated algorithm characterized each youth with T1DM or T2DM. We identified the proportion of youth who underwent ≥1 eye examinations by an ophthalmologist or optometrist based on healthcare encounter records. Kaplan-Meier survival curves estimated the time from first DM diagnosis to initial eye exam. Multivariate Cox proportional hazard regression models identified sociodemographic factors associated with undergoing an eye exam following DM diagnosis. Results: Among the 5515 eligible youth with T1DM and 7304 youth with T2DM, Kaplan-Meier survival analysis estimated that 60% and 38% had undergone an eye exam by 5 years after DM diagnosis, respectively. Children and adolescents with T1DM had 116% increased hazard of undergoing an eye exam by 5 years compared to youth with T2DM (HR 2.16, 95% CI 1.98-2.35). Blacks and Latinos had 11% and 18% decreased hazard of undergoing an eye exam by 5 years compared to Whites, respectively (Blacks HR 0.89, 95% CI 0.79-0.92; Latinos HR 0.82, 95% CI 0.73-0.92). As household net worth increased, youth were increasingly more likely to undergo an eye exam by 5 years (HR 1.46, 95% CI 1.30-1.62 for net worth ≥$500,000 vs <$25,000). Conclusions: Youth with T2DM are significantly less likely to undergo ophthalmic screening than youth with T1DM. Blacks, Latinos, and youth from less affluent families are significantly less likely to undergo a timely eye exam to check for DR than whites and youth from more affluent families. These groups are an underserved population that should be targeted in efforts to increase adherence to ophthalmic screening guidelines to prevent sight-threatening complications from DR. Commercial Relationships: Sophia Wang, None; Chris A. Andrews, None; Thomas W. Gardner, None; Michael Wood, None; Kanakadurga Singer, None; Joshua D. Stein, None Support: Research to Prevent Blindness; the Kellogg Foundation Program Number: 5562 Poster Board Number: D0067 Presentation Time: 3:45 PM–5:30 PM Modeling Clinical Workflow In Pediatric Ophthalmology Michelle Hribar1, Sarah Read-Brown2, Leah G. Reznick2, Thomas Yackel1, Michael F. Chiang2, 1. 1Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR; 2 Ophthalmology, OHSU, Portland, OR. Purpose: Pediatric ophthalmologists have raised concerns that EHRs negatively impact clinical productivity, but lack guidance about how to improve efficiency. This study demonstrates proof-ofconcept simulation models using EHR timestamp data may be used to improve clinic workflow. Methods: Clinical workflow was mapped for a single pediatric ophthalmologist (LGR). EHR databases were used to identify timestamps that best correlated with clinical activities during one year (2258 patient visits, 496,301 timestamps). EHR timestamps were validated against manual timings of activities for 89 patient visits by trained observers. Data were used to develop computer simulation models (Arena; Rockwell, Wexford, PA) to evaluate different scheduling policies and clinic configurations for minimizing patient wait time. Results: EHR timestamp data were within 3 minutes of manual observed times in 95/146 (65%) of clinical activities. EHR timestamp data shows mean wait time was 36 ± 26 minutes/patient per visit. Simulation models were used to evaluate new scheduling strategies and clinic configurations. We determined that scheduling patients requiring shortest times earlier, and those requiring longer times later, should reduce wait time from 37 to 15 minutes/patient. This optimized schedule was implemented in the clinic setting (3 sessions, 30 patients), and decreased mean wait time to 31± 22 minutes/patient (p=0.04). Further, we determined that using 2 staff members and 3 exam rooms provides the best marginal returns for reducing wait time as shown in Figure 1. Conclusions: These study findings indicate that EHRs can be extended toward a holistic tool for managing clinical workflow. EHR These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts timestamp data may be used to develop computer simulation models for testing alternative clinic configuration and scheduling policies, which have potential to decrease patient wait time. Figure 1: Effects of varying the number of staff and the number of exam rooms on patient wait time. We conclude that 2 ancillary staff members and 3 exam rooms is a good configuration for reducing patient wait time. Commercial Relationships: Michelle Hribar, None; Sarah Read-Brown; Leah G. Reznick, None; Thomas Yackel, None; Michael F. Chiang, None Support: NLM grant K99LM012238; NIH Core Grant P30 EY010572; unrestricted grant from Research to Prevent Blindness Program Number: 5563 Poster Board Number: D0068 Presentation Time: 3:45 PM–5:30 PM Noncompliance with Vision Care Guidelines in Chinese Americans with Type 2 Diabetes Mellitus Chunyi Hsu, Xuejuan Jiang, Mina Torres, Rohit Varma. Ophthalmology, University of Southern California, Los Angeles, CA. Purpose: The American Diabetes Association (ADA) guidelines recommend yearly dilated eye exams for type 2 diabetes mellitus (T2DM) patients. Compliance with ADA guidelines among Asian Americans may be more difficult because of additional barriers of language, differences in cultures, and the shortage of resources due to the minority status of the population. We aim to assess the prevalence of noncompliance with ADA vision guidelines among 50+ years old Chinese Americans with T2DM and identify personal risk factors associated with noncompliance. Methods: Data were from the population-based Chinese American Eye Study. All participants with a self-reported history and treatment of diabetes were asked about health and vision care utilization and diabetes self-care. Noncompliance was defined as having had no dilated eye examination in the previous 12 months. Logistic regression analyses were used to identify personal factors associated with noncompliance. Results: Among the 540 Chinese Americans who self-reported having physician-diagnosed diabetes, 324 (60%) had not complied with ADA guidelines. When compared with those with T2DM who complied with ADA guidelines, noncompliers were more likely to be younger (50-59 vs. 80+ years old: odds ratio [OR], 4.36; 95% confidence interval [CI], 2.25-8.45), have never been advised by a physician to have annual eye exams (OR, 2.20; 95% CI, 1.493.24), have no usual place for care (OR, 3.11; 95% CI, 1.65-5.88), and have a glycosylated hemoglobin level ≥ 8.0% (OR, 2.17; 95% CI, 1.11-4.25). Conclusions: Our data suggest that similar to Hispanics and African Americans, a majority of Chinese Americans with T2DM are not receiving recommended vision care. This high rate of noncompliance is unexpected given the high level of education of these Chinese Americans. Intervention programs targeted at Chinese Americans should focus on improving psychosocial predictors such as lower intentions (e.g. personal agency), salience of the behavior (e.g. recommendations from a physician), and local constraints instead of systemic constraints (e.g. financial barriers, lack of insurance). Commercial Relationships: Chunyi Hsu, None; Xuejuan Jiang, None; Mina Torres, None; Rohit Varma, None Support: grants EY-017337 from the National Eye Institute, National Institute of Health, Bethesda, Maryland and an unrestricted Departmental grant from Research to Prevent Blindness, New York, NY 10022 Program Number: 5564 Poster Board Number: D0069 Presentation Time: 3:45 PM–5:30 PM FDA Class I recalls of approved ophthalmic drugs and medical devices from 2003–2015 Ankur Gupta1, Rushi K. Talati2, Steve Xu3, Comeron Ghobadi4. 1 Ophthalmology, Washington University in St. Louis, St. Louis, MO; 2Ophthalmology, Northwestern University, Chicago, IL; 3 Northwestern University School of Medicine, Chicago, IL; 4 University of Chicago Pritzker School of Medicine, Chicago, IL. Purpose: The strength of clinical data needed for novel therapeutics to satisfy safety and efficacy thresholds for Food and Drug Administration (FDA) approval has long remained controversial. Although the traditional pre-market approval (PMA) process is the most stringent regulatory system in place worldwide, there remains significant weaknesses in the system. The continued development of new technologies invariably places strain on the the FDA’s limited resource capacity. We performed a retrospective, observational study to assess high risk device recalls, regulatory trends, and policy implications for the future. Methods: This IRB-exempt study utilized the FDA Center for Devices and Radiological Health database for Class I ophthalmic device recalls from 2003 to 2015. Approval data and recall characteristics were collected for each device. Additionally, reports of adverse events related to the manufacturer’s reason for recall were collected for each device using the FDA Manufacturer and User Facility Device Experience database. Results: Twelve Class I ophthalmic recall events were identified, constituting 68,820,497 total products (Figure 1). Nine out of 12 recalls resulted in at least one documented report of patient injury. Soft contact lenses, contact lens solution, and excimer laser systems were the most commonly recalled device classes. Six recalls occurred after 2011 (Figure 2). Five devices were cleared under the 510(k) pathway, 5 were cleared under the PMA pathway, 1 was exempt, and 1 was marketed without clearance. Three recalls were attributed to pre-market issues, 5 to post-market issues, and 4 were undetermined. An average of 5,735,041 devices were recalled per event and all but 2 devices had a worldwide distribution at the time of recall. Conclusions: It is important for ophthalmologists to understand recent high risk device recalls within their field as well as the current state of device regulation. Our results highlight the broad impact ophthalmic recall events have for both manufacturers and consumers. Although the absolute number of Class I recalls are low, the number of devices and patients affected extends to tens of millions. In the wake of recent legislation that further decreases evidence leading to device approval, policy makers must strive to maintain stringent approval and post-market surveillance standards in order to ensure patient safety and confidence. These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Commercial Relationships: Ankur Gupta, None; Rushi K. Talati, None; Steve Xu, None; Comeron Ghobadi, None Program Number: 5565 Poster Board Number: D0070 Presentation Time: 3:45 PM–5:30 PM Potential Microbial Contamination of Ophthalmic Solutions Commonly Used in Ophthalmology Outpatient Settings Nathan Harms1, Yasir J. Sepah1, Laura Creamer1, Salman Sarwar1, Mohamed K. Soliman1, Mohammad A. Sadiq1, Aniruddha Agarwal1, Angela Hewlett2, Diana V. Do1, James W. Gigantelli1, Quan Dong Nguyen1. 1Ophthalmology, University of Nebraska Medical Center, Omaha, NE; 2Department of Internal Medicine Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE. Purpose: To determine the rate of microbial contamination of three commonly used eye drops following regular clinical use. Methods: Bacterial cultures from 120 labeled bottles (stored at room temperature in clinics) of Fluorescein Sodium, Proparacaine, and Tropicamide were obtained at days 0, 28, 42, and 56 following regular clinical use by plating 100 μl volume onto chocolate agar and incubating at 37° C for 48 hours. Results: Rates of bacterial contamination were found to be 1.66, 2.75, 0 and 0% at days 0, 28, 42 and 56, respectively. Conclusions: Eye drops may be used safely for up to 56 days (potentially longer with additional testing) following regular clinical use without significant risk of microbial contamination, most likely secondary to self-sterilizing property (presence of preservatives) of the solutions. Figure 1 Figure 2 Figure 1. One hundred twenty bottles of Fluorescein Sodium (n=40), Proparacaine (n=40), and Tropicamide (n=40) placed into service within Truhlsen Eye Institute were cultured, with rates of bacterial contamination found to be 1.67 (n=2), 2.73 (n=3), 0, and 0% at days 0, 28, 42, and 56, respectively. Of the solutions with positive bacterial cultures (n=5), four were contaminated with coagulase negative staphylococci and the remaining one with alpha hemolytic streptococci, both considered to be normal ocular flora. Commercial Relationships: Nathan Harms, None; Yasir J. Sepah; Laura Creamer, None; Salman Sarwar, None; Mohamed K. Soliman, None; Mohammad A. Sadiq, None; Aniruddha Agarwal, None; Angela Hewlett, None; Diana V. Do, None; James W. Gigantelli, None; Quan Dong Nguyen, None These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Program Number: 5566 Poster Board Number: D0071 Presentation Time: 3:45 PM–5:30 PM Academic Ophthalmology Visit Length Prediction Models Daria Spatar1, 3, Jonah Todd-Geddes2, Michael F. Chiang2, Michelle Hribar2, Peter Graven2, Leah G. Reznick2, Thomas Yackel2. 1 Engineering and Technology Management, Portland State University, Portland, OR; 2Oregon Health and Science University, Portland, OR; 3DMiCE, Oregon Health and Science University, Portland, OR. Purpose: To build a model to predict visit lengths based on a priori known visit characteristics for academic ophthalmology outpatient clinics and to modify it for pediatric ophthalmology clinic. Methods: Using electronic medical record (EHR) data for visits at Oregon Health & Science University (OHSU) Casey Eye Institute between 2/1/2006 and 10/1/2015, we estimated the statistical relationship between visit length and various a priori known visit characteristics for all subspeciality clinics. Length of visits are estimated by a linear model including the following patient predictors: - average prior visit length; - diagnosis; - travel distance; subspecialty; - age; - visit type (new/return); - sex - visit month, year and day of the week; - visited clinic volume For the pediatric ophthalmology clinic we used EHR data from 1/1/2013 to 12/31/2014. We modified the initial model to look closely at the exam time rather than the whole length of the visit. For this linear model we chose the following predictors: - age; - average prior exam length; - dilation status at visit; - visit type (new return, pre-op, and post-op); - diagnosis; - volume of clinic day Results: For the model including all the subspeciality clinics, average prior visit length, age (especially those > 60), and the indication of a new patient visit appear to have significant increasing effect on visit length. The model has an R-squared of 0.251. It is able to correctly predict 1 out of 4 actual visit lengths, which is considered good for healthcare prediction models. The modified pediatric model has an R-squared of 0.18. Significant predictors of the exam length are age, prior exam length, dilation, visit type, and diagnoses of strabismus, neurological disease and ROP. All of the variables have positive coefficients, except of ROP diagnosis. Conclusions: Both the general and modified models identified age, prior visit lengths, and visit type as main predictors of the visit and exam lengths. The modified model had a lower value of R-squared supposedly due to smaller dataset and fewer independent variables. The modified model was consistent with the provider’s experience and observations. While the current models’ predictive strength are typical for healthcare models, we feel they can be improved. We are investigating other factors, such as patient personality, as well as considering other non-linear models. Accurately estimating patient visit lengths can help anticipate clinic loads and improve clinic efficiency. Commercial Relationships: Daria Spatar, None; Jonah Todd-Geddes; Michael F. Chiang, None; Michelle Hribar, None; Peter Graven, None; Leah G. Reznick, None; Thomas Yackel, None Support: P30 EY010572, unrestricted grant from Research to Prevent Blindness, NLM grant 5T15LM007088-24, NLM grant K99LM012238 Program Number: 5567 Poster Board Number: D0072 Presentation Time: 3:45 PM–5:30 PM Impact of visual impairment on quality of life and poverty : Results from a 1 year follow up study in the Mwandama Millennium Village (MVP) Sangchul Yoon1, 2, Jihee Lee3, Youn Seung Kim2, Jin Kwan Park4, Kyoung Yul Seo2. 1Ophthalmology, National Medical Center, Seoul, Korea (the Republic of); 2Ophthalmology, Yonsei University College of Medicine, Seoul, Korea (the Republic of); 3London School of Economics, London, United Kingdom; 4Seoul National University Graduate School of Public Health, Seoul, Korea (the Republic of). Purpose: Prevention of blindness was not included in the millennium development goals (MDGs) even though there are plenty of evidence demonstrating the correlation between the property and blindness. We have evaluated the disproportionate magnitude of the socio-economic endowment of long-term community development project on blind patients by measuring the effectiveness of surgical intervention. Methods: The study is a one-year postoperative follow-up research measuring the effect of cataract surgery in the impoverished area conducted from in Mwandama MVP. Quality of Life along with Expenditure and Self-rated Wealth was measured on Surgically Treated Group (STG), Low Vision Group (LVG), and Normal Vision Group (NVG). There were 167 (STG: 58, LVG: 48, NVG: 60) and 144 (STG: 49, LVG: 49, NVG: 44) village dwellers participated. Difference in Differences (DID) was used for the analysis, and demographic factors such as age, sex, and marital status along with socio economic factors such as level of education, income, and occupation were used as control variables. Results: The basic demographic profiles of the cataract and normal vision group were not significantly different. There was significant increase in the score of EQ-5D and Visual Function related Quality of Life (VFQoL) after a year of the surgery in the STG (p=0.012, p=0.006), and the difference from NVG was not noticed at the endline. Scores regarding expenditure was lower in the STG compare to the LVG, but there was statistically significant increase in the group (p=0.012) at the endline, which is not very different from the one of NVG (p=0.64). NVG significantly tend to have more assets tham the other groups (p=0.008) from the beginning, and this fact does not change at the endline either. However, there has been a drastic change in the self-related wealth within a year after the surgery, which means subjective economical satisfaction of the surgery is high (p=0.002). Conclusions: Even at the height of a long-term development program, the blind individuals received an out of proportion socioeconomic benefit. This study evaluated the economical effectiveness of the cataract surgery by adopting DID model. Providing restoring vision treatment can make more people receive the benefits and achievement of community development projects, an in turn, it will increase economic impact. Commercial Relationships: Sangchul Yoon, None; Jihee Lee, None; Youn Seung Kim, None; Jin Kwan Park, None; Kyoung Yul Seo, None Support: Korea International Cooperation Agency Private-Public Partnership Program in 2014 Clinical Trial: National Health Science Research Committee (NHSRC) Malawi, NHSRC #1228 These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Program Number: 5568 Poster Board Number: D0073 Presentation Time: 3:45 PM–5:30 PM Eyes of Africa: Establishing Comprehensive Ophthalmology Clinical and Surgical Capabilities in Rural Malawi William E. Sponsel2, 3, Rand R. Allingham1, Jeff Rogers5, Elly Chemey5, Kate Coleman4, 6, Jenny Brockington5, Yohann Chikwatu5, Melissa Murphy6. 1Ophthlamology, Duke University, Durham, NC; 2University of Texas San Antonio, San Antonio, TX; 3Vision Sciences, University of the Incarnate Word, San Antonio, TX; 4Blackrock Clinic, Dublin, Ireland; 5Child Legacy International, Boerne, TX; 6Right to Sight, Dublin, Ireland. Purpose: 1% of Malawi’s population is bilaterally blind, 80% by treatable conditions. The ratio of eye surgeons in sub-Saharan Africa is <10-5 the level in developed nations, and glaucoma prevalence >5-fold higher. With widespread poverty, energy blackouts, paucity of surgeons, any prospect for evolving subspecialty level care within the existing healthcare system appears untenable. We attempt to bypass these barriers by creating state-of-the-art facility in a self-sustaining site 40 minutes from the national capital. Methods: With generous donations from industry, Child Legacy International (CLI; www.childlegacy.org), Sponsel Foundation, Right to Sight, and the International Society for Glaucoma Surgery (ISGS), have established state-of-the-art clinic (Fig 1) and operating rooms (Fig 2). Eyes of Africa Center of Excellence (EOA Center) is equipped to provide high standard care five days a week, staffed by an Ophthalmologic Clinical Officer (OCO) and Ophthalmologic Nurse (ON) with EMR. Wind and solar power provide electricity and clean water 24/7. Patients requiring laser or surgery are scheduled to see an ophthalmologist. 1/3 of patients seen in any day may be patients brought to the facility by the MD; 2/3 must be OCOscheduled indigent patients. Results: National University resident rotations with mentor supervision is scheduled. SLT, YAG, diode, and argon lasers, OCT, A-scan, FDT, CS, dual lanes, quality slit-lamps, phacos, posterior vitrector, Zeiss xyz/zoom operating scopes are all functional and in situ. Full time supervisor ophthalmologist is to be appointed in 2017. Local ophthalmologists and multinational eye teams from ISGS are scheduled to work together in the state-of-the-art diagnostic and therapeutic facilities. NIH-funded genetics research is under approval. Prospective studies of SLT for POAG, and refractive programs are under IRB review. Conclusions: Malawi’s best clinicians can now apply modern diagnostics and perform surgery at high standard with reliable energy supply. International teams of expert surgeons, technicians, nurses and optometrists will mentor and learn from local experts and trainees to help jump-start the Malawi eye care system. Eyes of Africa Clinic One of the Child Legacy Hospital Eye ORs Commercial Relationships: William E. Sponsel; Rand R. Allingham, None; Jeff Rogers, None; Elly Chemey, None; Kate Coleman, None; Jenny Brockington, None; Yohann Chikwatu, None; Melissa Murphy, None Program Number: 5569 Poster Board Number: D0074 Presentation Time: 3:45 PM–5:30 PM Proportion of Medical Only versus Surgical Ophthalmology Practices: Associations and Trends Yvonne M. Buys, Jonathan A. Micieli. Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada. Purpose: Ophthalmology is one of the few unique specialties in medicine that provides the opportunity for primarily medical, primarily surgical or combined medical and surgical practice however, it remains unknown what proportion of ophthalmologists have surgical vs medical only practices. The goal of this study was to assess the yearly proportion of ophthalmologists with a medical only practice over a 14-year period and the influence of gender and career stage. Methods: Retrospective population-based study in Ontario, Canada, a universal government funded healthcare system. Individual ophthalmologists’ yearly billings, gender and year of medical school graduation were accessed via the Medical Services database in IntelliHEALTH Ontario from 1999-2013. A surgical ophthalmologist was defined as one who performed 20 or more ophthalmological surgical procedures. The yearly proportion of medical only vs surgical ophthalmologists was obtained. The effect of gender and career stage (early (<10 years from graduation), mid (10-45 years) and late-career (>45 years)) was evaluated. In addition, productivity of medical versus surgical ophthalmologists was compared based on number of consultations and assessments. Results: The number of practicing ophthalmologists in Ontario increased from 410 in 1999 to 469 in 2013. The proportion of medical only versus surgical ophthalmologists changed little over the 14-year period, averaging 30.5% medical only and 69.5% surgical. Recent graduates showed a decreasing trend towards performing surgery of 1.6% per year whereas late-career ophthalmologists demonstrated an increasing trend of 1.5% per year. Female ophthalmologists were less likely to perform surgery than male ophthalmologists but showed an increasing surgical trend. Surgical ophthalmologists saw on average 1.6X the number of yearly consultations and assessments compared to their medical peers. Late-career ophthalmologists saw significantly fewer patients than their younger counterparts in each year studied. Conclusions: A significant number of ophthalmologists have medical only practices. A large majority of late-career ophthalmologists have transitioned to a medical only practice. A decreasing trend in the These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts proportion of young ophthalmologists performing surgery coincides with a growth of late-career surgical ophthalmologists which may be limiting surgical opportunities for new graduates. Commercial Relationships: Yvonne M. Buys, None; Jonathan A. Micieli, None Program Number: 5570 Poster Board Number: D0075 Presentation Time: 3:45 PM–5:30 PM Gerontology and low vision services provided by Australasian optometrists Barbara M. Junghans1, Anthea Cochrane3, Peter L. Hendicott2, Anna Palagyi4, Robert J. Jacobs5. 1Optometry and Vision Science, Univ of New South Wales, UNSW Sydney, NSW, Australia; 2 Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia; 3Optometry and Vision Sciences, University of Melbourne, Parkville, VIC, Australia; 4Injury Division, The George Institute, Sydney, NSW, Australia; 5Optometry and Vision Science, University of Auckland, Auckland, New Zealand. Purpose: Anecdotally, few optometrists specialize in the care of persons with permanent vision impairment by providing clinical assessments, rehab services or training in adaptive technologies. Is this due to inadequate training or is there some other reason? We investigated optometrists’ practice preparedness and management patterns for the older patient and those with low vision (LV). Methods: Cross-institutional ethics approval was gained in 2009 to survey all members of Optometry Australia and the New Zealand Association of Optometrists. The survey covered 39 areas including demographics and practice management, range of visual aids prescribed and referral patterns to visual rehabilitation agencies. Results: Of 359 responding optometrists, 56% had graduated within the past 20 years, 41% were employees, and 26% were practicing in rural areas. 12% of respondents did not cater at all for elderly clients through longer consultations, physical access assistance, or domiciliary visits, and 9% of respondents claimed a lack of confidence to do so. Only 11% provided almost all LV services (mainly older practitioners) and 58% essentially provided no LV services. 59% of all respondents referred LV patients to a rehabilitation agency, with 17% claiming this was due to lack of ability to manage the patient themselves. Even the most active LV care optometrists referred 9% of their LV patients to an agency. Of respondents who did provide LV services, 91% prescribed high addition spectacles, 75% hand magnifiers, 60% stand magnifiers, but only approximately 10% prescribed hi-tech aids. Of all respondents, 13% use an ophthalmic assistant in providing LV aids. Alma-mater did not affect prescribing habits significantly. Educationally, 24% and 29% of all respondents (the majority of whom were younger optometrists) indicated that an experience during optometric training helped them decide to provide gerontological and LV services respectively. Passion and empathy in teachers was reported as a strong motivator for graduands to take up these fields of care. Lack of experience with elderly and LV patients while at university appeared to underpin the lack of confidence in many. Conclusions: These data provide valuable insight into optometrists’ present capability to service an ageing population in Australasia, and to support directions for curriculum review to ensure graduating optometrists are appropriately skilled. Commercial Relationships: Barbara M. Junghans; Anthea Cochrane, None; Peter L. Hendicott, None; Anna Palagyi, None; Robert J. Jacobs, None Support: Australian Learning and Teaching Council Grant Ref: DS8-628 Program Number: 5571 Poster Board Number: D0076 Presentation Time: 3:45 PM–5:30 PM Direct-to-Consumer-Advertising in Ophthalmology Cherie Fathy1, Sahar Kohanim2. 1Vanderbilt School of Medicine, Nashville, TN; 2Ophthalmology, Vanderbilt Eye Institute, Nashville, TN. Purpose: $4.3 billion were spent on Direct to Consumer Advertisements (DTCA) in 2010, which reach a significant proportion of consumers and may increase pharmaceutical sales. DTCA for ophthalmologic conditions are present in popular print media; however, it is unknown how common ophthalmologic ads are in print media and what conditions are most commonly covered. Opponents argue that exposure to these ads may increase the likelihood of overprescribing, while proponents believe they may encourage patients to engage in beneficial conversations with their providers. We performed a content analysis to determine the prevalence and content of DTCA for ophthalmologic products in print media. Methods: 3 consecutive issues of 49 popular magazines were screened over a 3-month period for ophthalmologic advertisements. Each ad was evaluated for the following variables: type of advertisement, ophthalmologic condition covered, effectiveness claims, the presence of advertising appeals, and scientific data. Descriptive statistics were used to analyze the data. Results: 19 (39%) magazines had ophthalmologic advertisements. 11 unique ads were identified. Most were drug or product-specific. The median number of claims per advertisement was 4 (range, 1-11). The most common appeals addressed effectiveness (n=6) and product’s ease of use (n=5). None addressed curability. Refractive errors (n=5) and Keratitis Sicca (n=3) were the most common ophthalmologic conditions covered. 3 of 11 advertisements were gender-specific, marketing cosmetic contact lenses or cosmetic eye cream for women. Only 5 of the 11 ads referenced research studies and 5 encouraged patients to seek more information from providers. None of the ads provided data in the form of tables or figures. Only 2 ads provided a risk profile for their products, which were in smaller font and required a higher level of reading comprehension. All ads provided patient support for more information, most commonly through the Internet. Conclusions: DTCA for ophthalmologic conditions are present in popular print media, especially those targeting women. Our results suggest that marketing is limited to a few disorders in ophthalmology, which may not accurately reflect the most common ocular conditions in the United States. Ads often encourage patients to request prescriptions or more information from their providers. Further research is needed on the quality of information of these advertisements and their effect on the patient-physician relationship. Commercial Relationships: Cherie Fathy; Sahar Kohanim, None Program Number: 5572 Poster Board Number: D0077 Presentation Time: 3:45 PM–5:30 PM Does Type of Health Insurance Coverage Affect How Patients Newly Diagnosed with Open-angle Glaucoma are Managed? Ari D. Schuman1, Chris A. Andrews1, Paula Anne Newman-Casey1, Suzann Pershing3, 4, Joshua D. Stein1, 2. 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI; 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; 3Byers Eye Institute, Stanford University, Palo Alto, CA; 4VA Palo Alto Health Care System, Palo Alto, CA. Purpose: To determine what initial treatments are being given to patients newly diagnosed with open angle glaucoma (OAG) and whether they vary depending on type of health insurance coverage. These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Methods: A large commercial insurance claims database (OptumInsight) and the Medicaid Analytic Extract (MAX) were queried to identify patients throughout the United States newly diagnosed with OAG in 2008 and 2009 who had ≥1 year of continuous enrollment in the plan after initial OAG diagnosis and ≥3 years of prior plan enrollment with no pre-existing record of any glaucoma. These data were analyzed to determine the proportion of patients receiving treatment, whether the initial treatment was medical, laser, or incisional surgery, and the types of medications prescribed. Among patients with commercial insurance, copays for each medication class were examined to determine the extent patients were prescribed the least expensive option. Results: Patients on Medicaid (n=4429) had a higher proportion of treatment in the first year after diagnosis than 3947 patients with commercial insurance (76.0% vs. 67.8%, p<.0001). Among the patients receiving treatment, a similar proportion with commercial insurance and Medicaid were initially treated with medications (92% vs. 93%, respectively, p=.06). A greater proportion of patients with commercial insurance with OAG were initially treated with beta blockers (13.4% vs. 9.7%, p<.0001) while a greater proportion of Medicaid enrollees with OAG were treated with PGAs (79% vs. 77%, p=.02) and α-agonists (8.1% vs. 5.1%, p<.0001). Xalatan was the most commonly prescribed PGA for patients with commercial insurance and was also the most expensive agent for those with commercial insurance with a mean copay of $42.71. Lumigan ($30.70) and Travatan Z ($29.19), the other PGAs examined, had lower mean copays. Conclusions: Patients with Medicaid with OAG were more likely to receive treatment in the year after initial diagnosis compared to those with commercial insurance. While the reasons for this are unclear, it may be due to lower copays for medications, more severe disease, or less access to samples. Commercial Relationships: Ari D. Schuman, None; Chris A. Andrews; Paula Anne Newman-Casey, None; Suzann Pershing, None; Joshua D. Stein, None Support: The Kellog Foundation, Research to Prevent Blindness "Physician Scientist" Award, NEI K12EY022299 Program Number: 5573 Poster Board Number: D0078 Presentation Time: 3:45 PM–5:30 PM Eye health care delivery on Prince Edward Island: Does public funding policy alter unequal diagnosis by geographic residence? Yaping Jin1, 2, Richard Wedge3, Anam Khan2, Yvonne M. Buys1, Sherif El-Defrawy1, Qishen Chen4, Graham E. Trope1. 1 Ophthalmology and Visual Science, University of Toronto, Toronto, ON, Canada; 2Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 3Health PEI, Charlottetown, PE, Canada; 4Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada. Purpose: To investigate geographic patterns of eye health care delivery on Prince Edward Island (PEI). Methods: We analyzed PEI physician billing data from 2010-2012 in five areas defined by postal codes (Charlottetown, Summerside, Prince, Queens & Kings and Stratford). Examined eye conditions (glaucoma, cataracts and diabetes) were identified by related ICD9 codes. Provincial-insured eye care services were recognized using specialty codes. Postal codes were used to determine patient residential location and place of eye care provider’s office. Agestandardized rates were computed for comparisons. Results: During the study period there were 6 ophthalmologists practicing on PEI, 5 (83%) with offices in Charlottetown. There were 20 optometrists practicing on the island with offices across the province. Stratford is closest and Prince farthest from Charlottetown. Optometric services were not government-insured during the study period. To receive provincially-insured eye care services, 54% of islanders residing outside the Greater Charlottetown Area have to travel to Charlottetown. The prevalence of glaucoma visits per 100 people aged 40+ was higher in Charlottetown (6.10) and Stratford (6.38) and lower in the other areas with the lowest in Prince (3.85, p<0.05). A similar pattern was seen with the prevalence of cataract visits. Utilization of ophthalmologists per 100 people was also higher in Charlottetown (10.44) and Stratford (10.90) and lower in the other areas (7.74-8.92, p<0.05). The prevalence of diabetes visits per 100 people was higher in Prince (6.93) and Summerside (6.65) and lower in the other areas (5.44-6.10, p<0.05). However, the utilization of eye care services per 1000 diabetics in Charlottetown (6.58) and Stratford (6.69) was twice the utilization rate in Prince (3.05, p<0.05). Conclusions: Significantly higher utilization of ophthalmologists and higher prevalence of eye care visits was found in Charlottetown and its closest area Stratford where ophthalmologist offices were highly concentrated, suggesting better patient access and better detection of eye disease in these areas. Encouraging ophthalmologists to work in other areas and/or providing public funding for services by optometrists who work in all areas of PEI may alleviate the observed discrepancy in eye care access and eye disease diagnosis induced by geography. Commercial Relationships: Yaping Jin, None; Richard Wedge, None; Anam Khan, None; Yvonne M. Buys, None; Sherif ElDefrawy, None; Qishen Chen, None; Graham E. Trope, None Support: CIHR HRA 126901 Program Number: 5574 Poster Board Number: D0079 Presentation Time: 3:45 PM–5:30 PM Evaluation of access to eye care by driving time in the state of Washington Aaron Y. Lee1, Cecilia S. Lee1, Aaron P. Weingeist2, Russell N. Van Gelder1. 1Department of Ophthalmology, University of Washington, Seattle, WA; 2Clearview Eye & Laser, Seattle, WA. Purpose: Access to eye care remains a challenge in geographically disparate locations such as the state of Washington. The purpose of this study was to determine access to eye care by measuring driving These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts distance between population centers and eye care providers in the state of Washington. Methods: The 2012 Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services were used to identify providers actively practicing as optometrists and ophthalmologists. Open Street Map data for every road and its associated speed limits were utilized in the state of Washington to calculate the shortest path defined by driving time using Dijkstra’s algorithm. The 2010 US Census geospatial data at block group resolution was meshed with Open Street Map to calculate the shortest path between populated areas and the nearest eye care provider. Results: Of the 25,508 optometrists and 17,071 ophthalmologists in the national Medicare Provider Utilization and Payment Data from 2012, a total of 665 optometrists and 332 ophthalmologists were identified as practicing in the state of Washington. Over 2.6 x 105 driving routes were calculated and the shortest driving path and time were collected for each optometrist to the nearest ophthalmologist. Ninety percent of the population lives within 9.36 miles and 11.76 minutes of an eye care provider (Figure 1A,B). Driving routes between eye care providers were calculated (Figure 2). 94.6% and 97.6% of optometrists practice within 30 and 60 miles of an ophthalmologist, respectively. 97.6% and 99.6% of optometrists practice within 1 and 2 hours of an ophthalmologist. The median distance and driving time to the nearest ophthalmologist were 1.81 miles and 2.16 minutes respectively (Figure 3A,B). Conclusions: In the state of Washington, the majority of the population lives within close proximity of an eye care provider. Commercial Relationships: Aaron Y. Lee; Cecilia S. Lee, None; Aaron P. Weingeist, None; Russell N. Van Gelder, None These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Program Number: 5575 Poster Board Number: D0080 Presentation Time: 3:45 PM–5:30 PM Environmental Life Cycle Assessment and Costs of Phacoemulsification at Aravind Eye Hospital in Pondicherry, India Cassandra L. Thiel1, Emily Schehlein2, Osamah Saeedi2, Joel S. Schuman3, Alan L. Robin2, 4, Rengaraj Venkatesh5, 6, Ravindran R.D5, Ravilla D. Thulasiraj5. 1Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA; 2 Ophthalmology, University of Maryland School of Medicine, Baltimore, MD; 3Ophthalmology, University of Pittsburgh, Pittsburgh, PA; 4Ophthalmology, Johns Hopkins University, Baltimore, MD; 5Aravind Eye Care System, Madurai, India; 6 Glaucoma, Aravind Eye Hospital, Pondicherry, India. Purpose: There are increasing concerns about the environmental footprint and greenhouse gas emissions of healthcare, and the operating room is of particular focus. The Aravind Eye Care System has created an effective surgical model based on efficiency of time and cost, but what is the environmental footprint of this model? This study analyzes material use at Aravind Eye Hospital in Pondicherry (AEH-PDY), India and calculates the environmental emissions through Life Cycle Assessment (LCA). Methods: We quantified and weighed surgical materials used in phacoemulsification (phaco) at (AEH-PDY). Material flow maps documented the reuse and disposal of all surgical materials for each site; average costs of materials and their disposal were calculated using hospital accounting records. Collected data were input into an LCA framework using one phaco (one eye) as the functional unit and the perioperative period as the study boundaries. Emissions throughout materials’ life cycles were calculated using the robust life cycle inventory database ecoinvent 3 and the global impact assessment method CML-IA v3.02 World 2000. Results: Key contributors to the life-cycle environmental footprint of a single phaco at AEH-PDY include electricity, water use, and the production of single-use materials (Fig 1). Carbon emissions from surgical materials and their disposal (including reusable and singleuse items, Fig 2) average about 0.8kg CO2-eq per phaco, well below the reported average of 63.5kg CO2-eq per phaco in the UK (Morris, et al. 2013). Conclusions: Results show that Aravind’s efficiency-focused surgical model minimizes environmental emissions and costs associated with phaco. Aravind’s current initiative to install solar photovoltaic panels for electricity generation will likely further reduce their overall footprint. Given Aravind’s proven surgical outcomes (Haripriya, et al. 2012), other hospitals should consider components of this model when attempting to reduce the environmental and cost burdens of surgical care. Life-Cycle Environmental Impacts of Phacoemulsification (Phaco) at Aravind Eye Hospital, Pondicherry (AEH-PDY); *Cost does not include water or capital equipment Material Flow for Surgical Materials Used in Phacoemulsification (Phaco) at Aravind Eye Hospital, Pondicherry (AEH-PDY); ROReverse Osmosis, IOL- Intraocular Lens, ETO- ethylene oxide Commercial Relationships: Cassandra L. Thiel, None; Emily Schehlein, None; Osamah Saeedi, None; Joel S. Schuman; Alan L. Robin, Aerie, Biolight (C), Aerie, Glaukos (I), Aravind Eye Care System (S); Rengaraj Venkatesh, Aravind Eye Care System (S); Ravindran R.D, Aravind Eye Care System (S); Ravilla D. Thulasiraj, Aravind Eye Care System (S) Support: •Fulbright-Nehru Academic and Professional Excellence Award (Research) 2014-2015 Program Number: 5576 Poster Board Number: D0081 Presentation Time: 3:45 PM–5:30 PM Utility of the Postoperative Week 1 Examination and Postoperative Month 1 Dilated Examination after Cataract Surgery: A Pilot Study Durga S. Borkar1, Emily Gross2, Tave A. van Zyl1, Sherleen Chen1, Carolyn Kloek1, 2. 1Massachusetts Eye and Ear Infirmary, Boston, MA; 2Harvard Medical School, Boston, MA. Purpose: There is currently no preferred practice pattern for postoperative evaluation after cataract surgery. The purpose of These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts this retrospective, observational study is to assess the utility of the postoperative week 1(POW1) examination and postoperative month 1(POM1) dilated examination in the perioperative management of patients undergoing cataract surgery. Methods: Cases of cataract extraction by phacoemulsification performed by a single surgeon on the Comprehensive Ophthalmology Service at an academic practice in Boston, MA between 1/1/14 and 12/31/14 were reviewed. Detailed perioperative information was collected. Patients without significant intraoperative complications and a normal postoperative day 1(POD1) examination were included in the final data analysis. Data from the POW1 exam was reviewed to evaluate for a change in management from the initial plan on POD1. Additionally, the results of the dilated fundus examination performed at POM1 were reviewed. Results: 150 cases were reviewed. Of these, 15 patients were excluded. 5 patients had planned combined cataract extraction with pars plana vitrectomy, and 10 patients did not have both a POW1 and POM1 examination. The study population of 135 patients consisted of 83 women and 52 men ranging from 39 to 97 years old. In this population, 26 patients (19%) did not have a normal POD1 examination. This was most commonly due to elevated intraocular pressure in the operative eye. In the remaining 109 patients, the exam was as expected for POD1, and the surgeon’s standard steroid, NSAID, and antibiotic drop regimen was prescribed. At POW1, only 2 of these 109 patients had a change in postoperative management. Both of these patients had a retinal detachment associated with symptoms that prompted the patient to be seen prior to the scheduled POW1 visit. Similarly, at POM1, the dilated fundus exam revealed a new retinal finding in 1 asymptomatic patient. However, since this patient had a trace epiretinal membrane in the operative eye with a best-corrected visual acuity of 20/20, this did not change postoperative management. Conclusions: The results of this study suggest that the POW1 examination does not change postoperative management after cataract surgery in asymptomatic patients with a normal POD1 examination. Similarly, dilation at POM1 did not reveal any significant unexpected findings in asymptomatic patients. Commercial Relationships: Durga S. Borkar, None; Emily Gross, None; Tave A. van Zyl, None; sherleen chen; Carolyn Kloek, None Program Number: 5577 Poster Board Number: D0082 Presentation Time: 3:45 PM–5:30 PM Influence of gender and age on ophthalmologists’ billings from 1992-2014 Rana Greene, Yaping Jin, Ying Qi, Yvonne M. Buys. Ophthalmology, University of Toronto, Toronto, ON, Canada. Purpose: Physician resource management requires knowledge not only of headcounts but also capacity of care which is commonly reported as Full Time Equivalents (FTEs). Given the documented feminization of the ophthalmology workforce and the 7-fold increase in Canadian ophthalmologists aged ≥65 years since 1970, this study evaluated the influence of gender and age on billing patterns as a surrogate of capacity of care. Methods: Yearly Ontario Health Insurance Plan (OHIP) billings of all Ontario ophthalmologists from 1992-2014 were obtained from the Institute for Clinical Evaluative Sciences for this retrospective cohort study. Comparisons in yearly billings were made between genders and among all age groups using 5 year increments. For comparison similar data was evaluated for all Ontario physicians. Billing data was adjusted to 2014 Canadian dollars to account for inflation. Results: Median billings for ophthalmologists changed little from 1992-2005, then increased 1.8% yearly peaking in 2011 followed by a 4.5% decrease to 2014. For all Ontario physicians median billings decreased 0.67% yearly from 1992-2014. Median billings of female ophthalmologists were less than male ophthalmologists however this difference decreased over the study period with females billing 50.1% of male ophthalmologists’ in 1992 increasing to 78.2% in 2014, a 1.4% yearly increase. In comparison for all Ontario physicians the gender gap in billings changed little with female physicians’ median billings averaging 63.6% of males. In terms of age, highest billing was in the 35-54 year cohort. Although the lowest billing was in those >75, this group had the largest increase with median billings increasing 6.5X in the study period. In contrast those ≤35 were third highest billers in 2004 but second lowest from 2009-2014 with a 51% decrease in billings from 2004-2013. Those 70-74 had 115% increase in yearly median billings from 2007-2014 billing more than those ≤35 from 2009-2014. Conclusions: Median billings have decreased for Ontario ophthalmologists since 2011. Female ophthalmologists are slowly bridging the gender gap with median billings increasing from 50.1% of male billings in 1992 to 78.2% in 2014. Ophthalmologists aged 35-54 had the highest yearly median billings. Median billings of ophthalmologists aged >70 have increased while those ≤35 have decreased from 2009 suggesting delayed retirement may be affecting opportunities for recent graduates. Commercial Relationships: Rana Greene, None; Yaping Jin, None; Ying Qi, None; Yvonne M. Buys, None Program Number: 5578 Poster Board Number: D0083 Presentation Time: 3:45 PM–5:30 PM A major shift in ophthalmic surgical care in the United States from hospital outpatient departments to ambulatory surgery centers over the past decade Brian C. Stagg1, Nidhi Talwar2, Cynthia Mattox4, Paul P. Lee2, 3, Joshua D. Stein2, 3. 1Ophthalmology, Univ of Utah School of Medicine, Salt Lake City, UT; 2Department of Ophthalmology and Visual Sciences, University of Michigan, Medical School, Ann Arbor, MI; 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; 4Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, MA. Purpose: Utilization of ambulatory surgery centers (ASCs) is an alternative to traditional hospital outpatient departments (HOPDs) for ophthalmic surgery. The purpose of this study is to explore trends over the past decade in use of ASCs versus HOPDs for various types of ophthalmic surgeries among enrollees in a nationwide managed care network. Methods: Claims data from 2001-2012 capturing patients enrolled in a large U.S. managed-care network were analyzed to identify all patients undergoing incisional ophthalmic surgery (cataract surgery, strabismus surgery, cornea surgery, glaucoma surgery, and retina surgery). For each type of ophthalmic surgery, we identified whether it took place at an ASC or HOPD. Each year from 2001-2012, we determined the proportion of each type of ophthalmic surgery performed at ASCs versus HOPDs. Results: A total of 413530 patients underwent ≥1 type of incisional ophthalmic surgery during 2001-2012. The mean number of cataract, strabismus, cornea, glaucoma, and retina surgeries performed annually were 41526, 2626, 2381, 1096, and 5503, respectively. From 2001 to 2012, the proportion of cataract surgeries performed at ASCs increased 59% (from 43.7% to 69.7%), the proportion of strabismus surgeries performed at ASCs increased 153% (from 15.2% to 38.5%), the proportion of cornea surgeries performed at ASCs increased 55% (from 27.4% to 42.4%), the proportion of glaucoma surgeries performed at ASCs increased 32% (from 43.1% to 56.8%), and the proportion of retina surgeries performed at ASCs increased by nearly 2 fold (from 14.0% to 41.7%). These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Conclusions: Over the past decade the proportion of ophthalmic surgeries performed at ASCs has increased substantially. Over two thirds of cataract surgeries are now performed at ASCs and surgeons are increasingly using ASCs for subspecialty ophthalmic surgeries as well. Future analyses need to explore the impact of this shift in care on patient outcomes, patient satisfaction, and costs. Commercial Relationships: Brian C. Stagg, None; Nidhi Talwar, None; Cynthia Mattox, None; Paul P. Lee, None; Joshua D. Stein, None Support: Kellogg Foundation, Research to Prevent Blindness Program Number: 5579 Poster Board Number: D0084 Presentation Time: 3:45 PM–5:30 PM Retinal Surgery Case Selection and Safety in an Ambulatory Surgery Center versus Hospital Chase Miller1, Llewelyn Rao1, Joan Hornik1, Douglas Rowland2, 3. 1 Retina Associates of Cleveland, Cleveland, OH; 2DY Rowland Associates, Cleveland Heights, OH; 3Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH. Purpose: There has been a migration of retinal surgical cases over the past decade to ambulatory surgery centers (ASCs) from hospital outpatient surgery departments (HOPDs) due to increased efficiency. We evaluated retinal surgery case selection and safety in an ASC versus an HOPD. Methods: We retrospectively analyzed retinal surgical case selection and safety in a large single retinal specialty practice over a 5-year period (7-1-10 to 6-30-15). The total number of cases done at an ASC and an HOPD were reviewed and categorized by common procedural terminology (CPT), and the 10 most common CPT codes were analyzed. Categorical data were summarized by counts and percents. Relative frequencies of procedures were compared by the chi-square test of contingency table data or Fisher’s exact test. We assessed safety through review of medical incident reports and hospital admissions related to the procedures. Rates of incidents were calculated along with 95% confidence intervals (95% CIs) by the modified Wald method. Proportions of incidents were compared by Fisher’s exact test for all procedures, combined, as well for subgroupings, elective and emergent. We also reviewed the reasons that cases were scheduled at the HOPD over the ASC for the most recent 18 months (1-1-14 to 6-30-15). Results: Total ASC cases numbered 5737 vs HOPD 213. There was a significant (p < .001) difference in the relative frequencies of procedures at ASC vs HOPD for all 10 of the most common retinal surgery CPT codes. For safety, the rate of medical incidents was 7 in 5,737 procedures (0.12%) (95% CI: 0.05% to 0.26%) at ASCs and 0 in 213 procedures (0%) (95% CI: 0.00% - 2.13%) at HOPD. For all procedures aggregated, as well as for each subgrouping, elective and emergent, 95% CIs of ASCs and hospitals overlapped. Examining these data with Fisher’s exact test, there were no statistically significant differences in medical incidents, either for all procedures combined (p = .21) or for the subgroupings, elective and emergent (p > .99 for each subgrouping). There were 43 cases performed at the HOPD over the last 18 months: 30 scheduling conflicts, 6 insurance requirements, 5 pediatric cases, and 2 medical indications. Conclusions: There was significantly more utilization of the ASC over the HOPD for all categories of retinal surgery cases, elective and emergent, with no apparent medical safety concerns. Commercial Relationships: Chase Miller; Llewelyn Rao, Cleveland Eye and Laser Surgery Center (I); Joan Hornik, None; Douglas Rowland, None Program Number: 5580 Poster Board Number: D0085 Presentation Time: 3:45 PM–5:30 PM Analysis of the cost savings from applying optical coherence tomography (OCT) to guide treatment for choroidal neovascularization Kevin D. Frick1, Sissi Sun1, David Huang2. 1Johns Hopkins Carey Business School, Baltimore, MD; 2Oregon Health Science University, Portland, OR. Purpose: We compare the cost per patient per month (PMPM) of using OCT to guide treatment decisions before administering ranibizumab with the cost of not using OCT and administering ranibizumab every month as recommended by the FDA for the treatment of choroidal neovascularization (CNV). We use a population of 143,000 Medicare patients being treated with ranibizumab for CNV in 2012. Methods: In the Centers for Medicare and Medicaid Services 2012 database, the average amount that is paid to the manufacturer is $391.41 for a 0.1 mg dose of ranibizumab. The actual amount paid to physician is the manufacturer price plus 6%, or $414.89. The most common dosage is 0.5mg, making the average $2,074.45. This service is provided to Medicare patients under Medicare’s Part B program for physician services, outpatient allied health services and drugs provided as part of a procedure. Medicare patients have to pay a 20% co-payment for this service. The Medicare payment amount for per OCT scan is $44.56. The billing codes are called “HCPCS codes” within the Medicare system. For OCT, the HCPCS code is “computerized ophthalmic diagnostic imaging, posterior segment; retina”, 92134. The percent of doses avoided is from a literature review of PubMed. Using the FDA-recommended 12 injections per year to equal 100%, an average non-injection rate of 44.3% is found with OCT performed. This allows patients to avoid unnecessary injections almost one-half of the time. Results: The cost of providing the FDA-recommended monthly dose of 0.5mg ranibizumab to 143,000 patients would be $296,646,350/ month. The cost of using OCT to guide treatment decisions–assuming monthly OCT scans–would be $6,372,080. When providing the dose of ranibizumab to only 79,651 individuals per month, the cost of the injections is $165,232,017. The total cost when using OCT on all patients and administering only the necessary doses of ranibizumab is $171,604,097. The cost saving for a population of 143,000 patients is $125,042,253, or $874 PMPM. Conclusions: The use of OCT to guide treatment decisions for patients with CNV saves momey and improves the quality of the patient care experience. This combination suggests supporting reimbursement for this use of the technology and promoting its use by ophthalmologists. If ophthalmologist income is at risk the payment system could be redesigned as pay for performance. These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts were significantly associated with variation in these VA outcomes. Significant variation between centers persisted even after adjusting for these factors. Conclusions: There are differences in VA outcomes between centers in the UK. These differences are influenced, but not completely explained, by factors such as patient age, starting VA, number of injections and visits. These data provide an indication of the VA outcomes that are achievable in real world settings. Commercial Relationships: Gerald Liew, None; Aaron Y. Lee, None; Javier Zarranz-Ventura, None; Catherine A. Egan, None; Robert Johnston, Medisoft (I); Adnan Tufail, None Commercial Relationships: Kevin D. Frick, Vision Impact Institute (S); Sissi Sun, None; David Huang, Optovue, Inc. (F), Optovue, Inc. (R), Carl Zeiss Meditec, Inc. (P), Optovue, Inc. (I), Optovue, Inc. (P) Program Number: 5581 Poster Board Number: D0086 Presentation Time: 3:45 PM–5:30 PM Inter-Center Variation in Visual Acuity and Establishing RealWorld Measures of Care: Results from the UK Neovascular AMD Database Report 4 Gerald Liew1, Aaron Y. Lee2, Javier Zarranz-Ventura3, Catherine A. Egan4, Robert Johnston3, Adnan Tufail4. 1 Ophthalmology, University of Sydney, Sydney, NSW, Australia; 2 University of Washington, Seattle, WA; 3Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; 4Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Purpose: Although international variations in visual acuity (VA) outcomes of eyes treated for neovascular age-related macular degeneration (nAMD) are well documented, intra-country intercenter regional variations are not known. This data is important for national quality outcome indicators. Methods: Multi-center national database study of 13 geographically distinct centers involving 5,811 treatment naive eyes of 5,205 patients receiving 36,206 ranibizumab injections in the UK. Participating centers used 3 monthly loading injections + pro-re-nata (PRN) retreatment regimens. Results: Mean starting VA between centers varied from 48.9 to 59.9 ETDRS letters. Mean VA change from baseline to 12 months varied from +6.9 letters to -0.6 letters (mean of +2.5 letters). By contrast inter-center variation in VA change from the end of the loading phase to 12 months varied from +2.6 to -3.4 letters (mean of -1.5 letters). The proportion of eyes achieving VA of 70 letters or more varied between 21.9 and 48.7% at 12 months. Median number of injections at each center varied from 5 to 8 with an overall median of 6, and median number of visits from 9 to 12 with a median of 11. Age, starting VA, number of injections and visits but not gender Program Number: 5582 Poster Board Number: D0087 Presentation Time: 3:45 PM–5:30 PM Lifetime Costs and QALYs for POAG patients, early stage versus moderate stage treatment:A Preliminary Discrete Event Simulation cohort study Hla M. Htoon1, 9, Duc Quang Nguyen2, Baskaran Mani7, 9, Steffen Bayer3, Sean S. Lam4, Monisha E. Nongpiur7, 9, Tin Aung7, 8, Eranga N. Vithana6, 9, Ecosse L. Lamoureux5, 3, David Matchar3. 1 Statistics, Singapore Eye Research Institute, Singapore, Singapore; 2 Industrial and Systems Engineering, National University of Singapore, Singapore, Singapore; 3HSSR, Duke-NUS, Singapore, Singapore; 4SingHealth Health Services Research Centre, Singapore, Singapore; 5Health Services Research, Singapore Eye Research Institute, Singapore, Singapore; 6Laboratory Translational Research, Singapore Eye Research Institute, Singapore, Singapore; 7Glaucoma, Singapore Eye Research Institute, Singapore, Singapore; 8Glaucoma, Singapore National Eye Centre, Singapore, Singapore; 9Eye ACP, Duke-NUS, Singapore, Singapore. Purpose: To compare the lifetime costs and quality-adjusted life years(QALYs)of primary open-angle glaucoma(POAG)patients commencing treatment at early (mild) and moderate stages in Singapore Methods: The model was structured as a patient-level discrete event simulation, based on the van Gestel et.al.’s model(2012) which tracked the natural course of POAG. POAG was defined as glaucomatous optic neuropathy with compatible visual field loss. Stages of POAG were defined as per the mean deviation values on automated perimetry viz.mild(early)≥-6dB, moderate<-6dB to -12dB, and severe ≤-12dB. Life time costs included direct costs(consultation, medication, laser, surgical, hospitalization, and low vision care costs). QALYs were assessed using the Health Utility Index Mark3(HUI3). Data parameters were estimated from a Singapore POAG cohort where possible;otherwise literature estimates were used. Validation was performed based on outputs with the cohort data. Heterogeneous cohorts of 3000 patients were simulated; and lifetime costs and QALYs were accumulated. Probabilistic sensitivity analysis was used to estimate confidence ranges(CR). Sensitivity analysis was performed to account for a presumed 10-year lead-time bias for individuals with mild disease, and the possibility that due to selection bias the moderate cohort had more severe disease(adjusted by increasing the hazard ratio for worsening disease in the mild cohort to1.03) Results: Patients with initial early POAG and who progressed to moderate stage had higher lifetime QALYs(1.51=19.7 95%CR 19.7-19.77compared to those who were initially moderate and progressed -18.22;95%CR 18.2-18.26). There was a similar pattern of lower costs for initial early POAG (S$-14,941=S$33,960;95%CR 33,866-34,054 compared to those who commenced treatment at a moderate stage -S$48,901;95%CR 48,789-49,012). The trend for lower lifetime costs and higher QALYs remained even after sensitivity analysis(Table). Cost and QALYs for baseline and sensitivity results are shown graphically(Figure) These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts Conclusions: Early treatment of POAG appears to have lower life time costs and higher QALYs compared to initiating treatment at a moderate stage. Our data suggest that early treatment is cost effective, perhaps even economically dominant;however, we cannot exclude the possibility that individuals with moderate POAG at onset of treatment have a more aggressive and costly disease Commercial Relationships: Hla M. Htoon, None; Duc Quang Nguyen, None; Baskaran Mani, None; Steffen Bayer, None; Sean S. Lam, None; Monisha E. Nongpiur, None; Tin Aung, None; Eranga N. Vithana, None; Ecosse L. Lamoureux, None; David Matchar, None Support: SHF/HSR081/2014 Program Number: 5583 Poster Board Number: D0088 Presentation Time: 3:45 PM–5:30 PM Cost-effectiveness of FDA-approved anti-VEGF treatments for diabetic macular edema Steve Duff1, Nancy Holekamp2, Yamina Rajput3. 1Veritas Health Economics Consulting, Carlsbad, CA; 2Pepose Vision Institute, Chesterfield, MO; 3Genentech, Inc., South San Francisco, CA. Purpose: Diabetic macular edema (DME) is a complication of diabetic retinopathy that can lead to vision loss if untreated. Visual impairment and blindness due to DME have become escalating clinical and economic issues as the number of diabetic patients increases worldwide. This study evaluates the relative differences in the costs and quality-adjusted life years (QALYs) of the two approved anti–vascular endothelial growth factor (VEGF) therapies, aflibercept and ranibizumab, in patients with DME. Methods: A model was developed using one-year patient-level visual acuity (VA) data from the DRCR.net Protocol T study—a head-tohead randomized controlled trial of anti-VEGF treatments for DME. In addition to the costs of treatment with aflibercept (2.0 mg) or ranibizumab (0.3 mg) (given at baseline and up to every 4 weeks using defined retreatment criteria), VA-related medical costs and QOL were simulated based on 8 VA health states. Costs (2015 USD) for treatments, adverse events (AEs) and VA-related resources were based on Medicare reimbursement and literature. VA-related utilities were determined by a published algorithm. Costs and QALYs were quantified for two patient groups based on baseline VA: 20/40 or better and 20/50 or worse. Results: One-year total costs (for treatment, AE management, and visual impairment) and QALYs for ranibizumab vs. aflibercept were: $16,624 vs. $24,460 and 0.767 vs. 0.767 in the better VA group and $20,141 vs. $30,416 and 0.710 vs. 0.720 in the worse VA group. Comparing aflibercept to ranibizumab, the incremental cost-effectiveness ratio (ICER) was $964,607/QALY in the worse VA group which far exceeds conventional ICER thresholds for recommended product adoption. An ICER was not calculated in the better VA group because ranibizumab is less costly and equally effective. While ICERs were sensitive to assumptions about the relative weighting of the better- and worse-seeing eye on patient outcomes, conclusions remained unchanged. Conclusions: Although anti-VEGF treatments for DME are associated with high costs, the increase comes with improved visual acuity and QOL benefits. Treatment with aflibercept is more costly than with ranibizumab and yields only similar or nominal increases in QALYs. Therefore, based solely on this health economic analysis of FDA-approved anti-VEGF treatments, aflibercept is not cost-effective when compared to ranibizumab for DME patients based on one-year results. Commercial Relationships: Steve Duff, Genentech, Inc. (C); Nancy Holekamp, Genentech, Inc. (C); Yamina Rajput, Genentech, Inc. Support: Genentech, Inc., South San Francisco, CA, provided support for the study and participated in the study design; conducting the study; and data collection, management, and interpretation. Clinical Trial: NCT01627249 Program Number: 5584 Poster Board Number: D0089 Presentation Time: 3:45 PM–5:30 PM Cost Savings Enabled by Automated Diabetic Retinopathy Screening in a UK-like screening program Malavika Bhaskaranand, Chaithanya Ramachandra, Sandeep Bhat, Kaushal Solanki. Eyenuk, Inc., Woodland Hills, CA. Purpose: Current diabetic retinopathy (DR) screening setups employ fully manual grading of retinal images and therefore cannot scale to meet the needs of the large, growing diabetic population. Cost savings enabled by EyeArt – a fully-automated, high-throughput, cloud-based DR screening system – are demonstrated for a grading setup similar to the UK NHS Diabetic Eye Screening Program. Methods: In the manual grading system, all patient episodes are reviewed by level 1 graders who identify normal patients and recommend re-screening in 12 months. All other episodes are forwarded to level 2 outcome graders who determine referral status or re-screening interval based on the DR severity and surrogate markers for clinically significant macular edema (CSME). These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts EyeArt automatically analyzes multiple fundus images captured during a patient episode and generates a screening recommendation, while flagging external eye images and poor quality images. We evaluate cost savings enabled by EyeArt when level 1 graders are replaced by EyeArt and patient episodes recommended for referral by EyeArt are forwarded to the level 2 outcome graders. For this analysis, costs associated with manual grading and quality assurance (QA) grading in UK sterling for the year 2005-06; number of QA reviews per grader per year; and performance of level 1 graders are obtained from Scotland et. al (Br J Ophthalmol 2010; 94:712-719). The DR severity prevalence rates are from Kapetanakis et. al (J Med Screening 2015; 22(3):112-118). Results: Assuming the annual number of DR screening episodes to be 2.7 million based on the current diabetic population in the UK, the annual cost of fully manual grading is estimated to be £12,000,709 (level 1 grading cost=£7,992,000; level 2 grading cost=£2,784,409; QA cost=£1,224,300). EyeArt achieves 85% sensitivity at 86% specificity at detecting episodes with pre-proliferative/proliferative DR or surrogate markers for CSME on a real-world dataset with 2045 episodes. Therefore, with EyeArt replacing level 1 graders, the level 2 grading cost is £3,626,974 and with QA review of 6% of episodes, the QA cost is £528,000. Therefore without considering the cost of EyeArt or the benefits of EyeArt’s higher sensitivity compared to level 1 graders, the economic value added by level 1 automated grading is £7,627,054. Conclusions: Automated DR screening using EyeArt can provide significant cost savings in DR screening programs. Commercial Relationships: Malavika Bhaskaranand, Eyenuk, Inc. (P), Eyenuk, Inc.; Chaithanya Ramachandra, Eyenuk, Inc., Eyenuk, Inc. (P); Sandeep Bhat, Eyenuk, Inc. (P), Eyenuk, Inc.; Kaushal Solanki, Eyenuk, Inc., Eyenuk, Inc. (P) Support: Research reported in this publication was supported by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number R44EB013585. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Program Number: 5585 Poster Board Number: D0090 Presentation Time: 3:45 PM–5:30 PM Generic glaucoma medication costs: a 2 year analysis Eunmee Yook, Robert D. Fechtner, Albert S. Khouri. Dept of Ophthalmology & Visual Science, Rutgers, Hoboken, NJ. Purpose: Generic medication use has become mainstream with recent health care changes, however prescribers may not be aware of price fluctuations of medications over time. We conducted a prospective, observational study to analyze variations of generic glaucoma medication costs for 2014-2015. Methods: Cash “out of pocket” prices were collected from 5 national pharmacy chains (pharmacy A,B,C,D,E) after inquiries were made over telephone and web search. Medications included: 1) Latanoprost, 2) Timolol, 3) Dorzolamide, 4) Timolol /dorzolamide, 5) Brimonidine 0.15% 6) Brimonidine 0.2%. Data from 2015 was adjusted by the U.S. inflation rate for statistical purposes. Means, standard deviation, and percent change were calculated. Data from 2014 and 2015 were analyzed using Student T-Test. Results: Means and standard deviation (SD) for medication costs are shown in table 1. We found that all 6 generic medications had increased in cost at a greater rate than the national inflation rate (P = 0.0098). When looking at each of the medication costs, the percent increase in cost ranged from 2.9% to 45%. Comparisons were also made between 2014 and 2015 for each pharmacy. Variation ranged 1.5% at pharmacy E to 22% at Pharmacy C. Comparing 2014 and inflation-adjusted 2015 prices, Timolol 0.5% had the greatest increase of 45%, then Brimonidine 0.2% with a 33% increase, Brimonidine 0.15% with a 10% increase, Latanoprost with a 6% increase, Dorzolamide with a 5.9% increase, and Timolol/dorzolamide with a 2.9% increase. Additionally, the increase in prices were variable across different pharmacies. Conclusions: The change in cost of 6 generic glaucoma medications across 5 national pharmacies was significant and very variable. The increase in cost of most generic medications significantly surpassed inflation. Cash paying patients and providers are encouraged to explore costs of different medications at various pharmacies in order to lower health care costs. Table 1. 2015 costs, mean, standard deviation (SD) Table 2. Amount and percentage increase in costs from 2014 Commercial Relationships: Eunmee Yook, None; Robert D. Fechtner, None; Albert S. Khouri, None Program Number: 5586 Poster Board Number: D0091 Presentation Time: 3:45 PM–5:30 PM The Cost of Glaucoma Medications Among Patients with Open Angle Glaucoma in a Clinical Population: A Pilot Study Roy Tan, Owen Kim Hee. Ophthalmology, Tan Tock Seng Hospital (National Health Group), Singapore, Singapore. Purpose: Glaucoma medication plays a major role in the treatment of patients with glaucoma, leading to increase burden of cost both to individuals, and society. Our study aims to study the cost of glaucoma medications among patient with open angle glaucoma, and to stratify according to the severity of the glaucoma. Methods: Patients with open angle glaucoma who were diagnosed at least five years prior, were studied. The glaucoma medications given during the years of follow up were analysed and the cost burden of glaucoma medications were calculated base on the current cost. The patients were stratified according to severity of glaucoma base on the Brusini Glaucoma Staging System. Results: There were a total of 76 patients with open angle glaucoma studied. Based on the Bascom Palmer Glaucoma Staging System, there were 2 patients in severity stage 0, 12 patients in stage 1, 13 patients in stage 2, 11 patients in stage 3, 16 patients in stage 4 and 21 patients in stage 5. The cost of medication per annum per patient These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record. ARVO 2016 Annual Meeting Abstracts for each stage is as follows – Stage 0, S$0; Stage 1, S$81.39; Stage 2, S$246.37; Stage 3, S$354.33; Stage 4, S$289.28; Stage 5, S$312.98. Conclusions: The cost burden of glaucoma medication is high among the moderate to advance stages of glaucoma. Further analysis should be done on the cost of other procedural and surgical treatment of glaucoma, and to analyse the cost burden of medication versus nonmedication treatment. Commercial Relationships: Roy Tan, None; Owen Kim Hee These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/ to access the versions of record.