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ARVO 2015 Annual Meeting Abstracts
218 Eye disease and delivery of health care
Monday, May 04, 2015 8:30 AM–10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 1372–1400/A0067–A0095
Organizing Section: Clinical/Epidemiologic Research
Contributing Section(s): Lens, Visual Psychophysics/Physiological
Optics
Program Number: 1372 Poster Board Number: A0067
Presentation Time: 8:30 AM–10:15 AM
Do persons with diabetes want to decide on their own when
treating diabetic retinopathy? The intended role of the
ophthalmologist – results of the DiabCheckOCT+ Study.
Lydia Marahrens1, Daniel Roeck1, Raimar Kern2, Tjalf Ziemssen2,
Andreas Fritsche3, Focke Ziemssen1. 1Center for Ophthalmology,
Eberhard Karls University, Tuebingen, Germany; 2Department of
Neurology, Autonomic and Neuroendocrinological Laboratory
Dresden, University Hospital Carl Gustav Carus at the Dresden
University of Technology, Dresden, Germany; 3Department of
Internal Medicine, Eberhard Karls University, Tuebingen, Germany.
Purpose: Physicians are not always aware of the risk to patronize
their patients. While some people explicitly request for a paternalistic
approach, disempowerment could contribute to unintended
passiveness and gaps in knowledge which are known to be associated
with worse metabolic control, especially in diabetes. In order to
assess the patient’s point of view on codetermination, a prospective
survey was initiated to assess the preferences for shared decisionmaking in a representative cohort.
Methods: The DiabCheck® trial was a non-interventional crosssectional study of 810 adults in 3 secondary diabetes care centers
during a period of 4 month. All patients of the investigator initiated
study were included after confirmed diagnosis of diabetes and
underwent a comprehensive eye examination. A questionnaire
evaluated demographic characteristics, diabetes duration and type of
treatment. Level of education and age were investigated as predictors
of patients’ role preferences for decision-making. For categorical
outcomes, χ2-test was used to test for significant differences in
participants’ characteristics by group. For continuous outcomes,
significant differences between strata were evaluated using a
Wilcoxon Signed-Rank test (α=0.05).
Results: A majority of 74.3% (599 of 806) preferred shared
decision-making. However, 17.4% selected a paternalistic approach
with a decision-making only by the treating ophthalmologist. The
preference for a patient-dominant decision was 8.3%. In contrast,
2.6% (21 of 806) wanted no medical and scientific information of the
ophthalmologist.
Participants wanting an ophthalmologist-dominant decision-making
where significantly older (>60 years) and had a lower level of
education (p<0.05). In this group, a wait-and-watch attitude was
more frequently seen. However, participants with a higher level of
education wished significantly more often to determine the preferred
treatment alone (p<0.05). Even those in both groups, aiming for
a unilateral decision mostly asked for a preceding exchange of
information (186 of 806).
Conclusions: Most persons with diabetes want to be partners in the
process of counseling and prefer shared treatment decision-making.
Ophthalmologists should be aware of the patients’ perspective
in order to encourage an active and self-determined setting of
individualized treatment targets.
Commercial Relationships: Lydia Marahrens, None; Daniel
Roeck, Novartis (F); Raimar Kern, Bayer-Schering (R), Biogen
Idec (R), Genzyme (R), Merck Serono (R), Novartis (R), Teva (R);
Tjalf Ziemssen, Almirall (R), Bayer-Schering (C), Bayer-Schering
(R), Biogen Idec (C), Biogen Idec (R), Deutsche Diabetes Stiftung
(F), Genzyme (R), GSK (R), Hertie Foundation (F), Merck Serono
(R), MSD (R), Novartis (C), Novartis (R), Roland Ernst Foundation
(F), Sanofi-Aventis (R), Teva (C), Teva (R), the Robert Pfleger
Foundation (F); Andreas Fritsche, None; Focke Ziemssen, Alcon
(R), Alimera (C), Allergan (C), Allergan (R), Bayer (C), Bayer (R),
Biogen (C), Biogen (R), Novartis (C), Novartis (F), Novartis (R)
Clinical Trial: NCT02311504
Program Number: 1373 Poster Board Number: A0068
Presentation Time: 8:30 AM–10:15 AM
Task Sharing in the Eye Care Workforce for Detection and
Management of Diabetic Retinopathy in Low Resource Countries
MUFARRIQ SHAH1, 2, Rahul Chakrabarti2, Ayesha Noor3, Gail
Ormsby2, Jing Xie2, Alex Harper2, Jill Keeffe4. 1Khyber Institute of
Ophthalmic Medical Sciences, Peshawar, Pakistan; 2Center for Eye
Research Australia, Department of Ophthalmology, University of
Melbourne, Melbourne, VIC, Australia; 3Vision and Dental Care
Clinic, Peshawar, Pakistan; 4LV Prasad Eye Institute, Hyderabad,
India.
Purpose: Team work approach and a co-management strategy
to screen, detect and manage diabetic retinopathy (DR) could
improve coverage of people with diabetes mellitus (DM) to prevent
vision loss. This study aimed to investigate the potential roles of
ophthalmologists and mid-level eye care workers in detection and
management of DR in low resource countries through Task Sharing.
Methods: Due to the explorative nature of the investigation, a
multi-phase mixed-methods approach was used. Data were collected
from stakeholders (policy level personnel, ophthalmologists and
other eye care workers). In phase one a situation analysis of DR to
identify strengths and weaknesses of the eye care service delivery
models for detection and management was performed in Cambodia
through semi-structured interviews (n=24). In phase two in Pakistan
a survey to assess stakeholders’ (n=101) attitudes, perceptions and
the feasibility for co-managed eye care for people with DM through
task sharing was conducted. That was followed by 22 key informant
interviews which focused on 7 themes including understanding
the situation and perspectives about eye care services for DR, task
shifting, policy and guidelines for task sharing.
Results: The Pakistan survey showed that 97% (n=56) of
ophthalmologists and all (n=43) eye care workers suggested
introducing task sharing for primary eye care (p=0.219). Most
ophthalmologists (97%) and eye care workers (98%, n=42) stated
that task sharing could potentially be effective in preventing vision
loss from DR (p=0.674). 98% (n=57) of ophthalmologists and all
(n=43) eye care workers reported that task sharing could strengthen
linkages amongst the health care workforce and community for more
efficient care for people with DM (p=0.387). About half of them
(57% vs 58%, p=0.022) believed that changes were required in laws
and policies for task sharing. The case study revealed that the positive
effects of task sharing included increased awareness of DR; potential
for development of a team work approach with better comprehensive
management and greater coverage without negative effects on each
eye care workers’ primary responsibilities.
Conclusions: Task sharing among all cadres of eye care workers
could help to achieve greater coverage to prevent visual loss from
DR. There is need of policy and guidelines to reinforce task sharing
in low resource countries.
Commercial Relationships: MUFARRIQ SHAH, None; Rahul
Chakrabarti, None; Ayesha Noor, None; Gail Ormsby, None; Jing
Xie, None; Alex Harper, None; Jill Keeffe, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 1374 Poster Board Number: A0069
Presentation Time: 8:30 AM–10:15 AM
Use of multi-center electronic medical record data to characterize
diabetic retinopathy in underserved and insured patients in
Chicago
Michael Mbagwu1, 3, Paul Bryar1, Kathryn Jackson2, 3, Charlesnika
Evans3, Theresa Walunas3, 2, Abel Kho3, 2, Dustin French1, 3.
1
Ophthalmology, Northwestern University Feinberg School of
Medicine, Chicago, IL; 2Center for Healthcare Studies, Northwestern
University Feinberg School of Medicine, Chicago, IL; 3Institute
for Public Health and Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL.
Purpose: Diabetes is the leading cause of blindness among United
States (US) adults 40 years and older. Diabetes and diabetic
complication rates have been shown to be higher in medically
underserved populations. Gaining insight into diagnosis and
ophthalmic care of minority, low-income, and uninsured patients
will provide a further basis to effectively prevent, detect, and treat
diabetic eye disease.
Methods: The HealthLNK database was used to identify
approximately 2 million unique patients who visited one of the
participating institutions from 2006-2012. HealthLNK includes
electronic medical record (EMR) data from 6 federally qualified
health centers (FQHCs), and 6 hospitals, including 4 academic
medical centers in the Chicago area. Diabetic patients were defined
by having ICD-9 codes for diabetes (250.xx) and/or diabetic
complications (357.2, 362.01-362.07, and 366.41). From this
population, patients with diabetic retinopathy (362.0-362.10, 362.1,
362.10, 362.14, 362.16, 362.2, 364.42) were elucidated. Diabetic
retinopathy patients with CPT codes related to diabetic retinopathy
treatment (67015, 67025, 67028-67031, 67036, 67039-67043, 67105,
67108, 67113, 67210, 67227, 67228) were further categorized.
Insurance status was also determined within each subgroup.
Results: Of the 1,933,082 patients in the HealthLNK database,
171,427 were identified as diabetics (representing a total prevalence
of 8.9%). 12,014 patients had diabetic retinopathy (7.0% of
diabetics). 2,143 patients had CPT codes related to diabetic
retinopathy treatment (17.8% of all retinopathy patients). There were
differences in the prevalence of both diabetic retinopathy in diabetics
(5.7% vs. 9.0%, p<0.01) and subsequent treatment (15.4% vs.
20.2%, p<0.01) when comparing “Medicaid/Financial Means Tested/
Uninsured” vs. “Medicare/Privately Insured” patients.
Conclusions: The prevalence of diabetic retinopathy and procedures
varied by insurance status, suggesting screening and treatment
disparities may exist in this population. Future work will need to be
done to elucidate the significance and reasons for these differences.
This also work provides rationale for targeted screening and
treatment strategies. The study also demonstrations the effectiveness
of using large multi-center EMR data such as HealthLNK to identify
healthcare disparities and design solutions to bridge this gap.
Commercial Relationships: Michael Mbagwu, None; Paul Bryar,
None; Kathryn Jackson, None; Charlesnika Evans, None; Theresa
Walunas, None; Abel Kho, None; Dustin French, None
Support: National Eye Institute Grant Number: 1R21EY02405001A1, Unrestricted grant from Research To Prevent Blindness, New
York, NY
Program Number: 1375 Poster Board Number: A0070
Presentation Time: 8:30 AM–10:15 AM
New Electronic Health Record and future implementation in a
multidisciplinary Low Vision Rehabilitation Center
Filippo Maria Amore, Valeria Silvestri, Marco Sulfaro, Simona
Turco. National Center of Services and Research for the Prevention
of Blindness and Rehabilitation of the Visually Impaired, Inter Agen
for Prev of Blindness IAPB Italy onlus, Roma, Italy.
Purpose: To describe one year activities in a low vision rehabilitation
center based on a multidisciplinary approach by means of a new
Electronic Health Record (EHR) in order to highlight the benefits
Methods: Clinical and functional data of patients assessed at our
low vision center were collected and analyzed retrospectively
through the use of nLIFE, a new EHR. nLIFE is easily customizable
to follow different needs, scenarios from stand-alone configuration
to big networks and to set interactive home training. The filling
of information is divided on several sections in order to properly
fit different kind of medical data. nLIFE is updated with different
modules including advanced search ability and scheduling of
resources to implement a full field approach to medical data
management. Eye disease, National Eye Institute 25 Item
Visual Function Questionnaire (VFQ-25), Best Corrected Visual
acuity (BCVA), Contrast Sensitivity (CS), Fixation stability,
Microperimetric retinal sensitivity, reading speed (RS) and aids
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
prescribed were evaluated. All data came from different modules and
tools and were processed in an ad-hoc database
Results: A total of 429 subjects were assessed. BCVA was collected
for 595 eyes with a mean of 0,72 (± 0,45) LogMAR. Further analysis
permitted to identify BCVA for the best eye with a mean of 0,64 (±
0,41). CS of 514 eyes was 0,88 (±0,54) LogC. Of 263 subjects who
completed microperimetric assessment, mean retinal sensitivity of
470 eyes was 5,43 dB (±5,22); fixation of 506 eyes resulted stable
in 258, relatively unstable in 129 and unstable in 120. Bivariate
Contour Ellipse Area of 500 eyes had a mean of 8,46 °2 (±29,9). Age
Related Macular Degeneration was the most frequent disease with
a prevalence of the atrophic one. RS mean was 34,8 word/minute;
medical filters were the most prescribed aid.VFQ25 was completed
by 193 subjects
Conclusions: EHR appears a valid tool for supporting clinicians.
nLIFE is based on the state of the art of web technology with
the possibility to receive data from different sources and
multidisciplinary modules. It can review clinical and research data
locally or through Internet and by using all device type. Besides it
allows a customized rehabilitative path and the development of an
interactive home training with advantages for the patients. All the
team showed high compliance to nLIFE with easier data collection
and analysis
Commercial Relationships: Filippo Maria Amore, None; Valeria
Silvestri, None; Marco Sulfaro, None; Simona Turco, None
Program Number: 1376 Poster Board Number: A0071
Presentation Time: 8:30 AM–10:15 AM
Digital Rapresentation Of Health Data To Improve Disease
Diagnosis And Treatment Of Degenerative And Vascular Disease
Of The Retina And Macula. (I-Maculaweb Project)
Riccardo Scotto1, Raffaella Rosa1, Donatella Musetti1, Maria
Musolino1, Mauro Gacomini2, Monica Bonetto2, Paolo Fraccaro2,
Carlo E. Traverso1, Massimo Nicolò1. 1DINOGMI, Eye Clinic,
Genova, Italy; 2DIBRIS, University of Genoa, Genova, Italy.
Purpose: To provide physicians a clinical decision support system in
the context of degenerative and vascular disease of the retina.
Methods: I-Maculaweb is based on a model already available. The
unique and innovative scientific and technological element of the
project is the integration with the individual and population data
relevant for the degenerative and vascular diseases of the macula. The
system is able to integrate the inclusion criteria for the identification
of subjects to be enrolled for clinical trials. The proposed system take
advantage of the personal medical data accumulated over time and
different diagnostic and treatment algorithms in order to be a Clinical
Decision Support System.
Results: The system operates from March 2013. Until December
2014, 1067 patients had been registered. Moreover, 3479 visits,
1455 intravitreal injections and 246 laser treatments have been saved
in the database. More frequent diagnosis are Age-related Macular
Degeneration (386 patients), Diabetic Retinopathy (199 patients),
Central Serous Chorioretinopathy (104 patients) and retinal vein
occlusion (49 patients).
Conclusions: The web-platform allows effective management,
sharing and reuse of clinical information within primary care and
clinical research. The system is user-friendly and can be effectively
integrated into the physician workflow and real-life.
Commercial Relationships: Riccardo Scotto, None; Raffaella
Rosa, None; Donatella Musetti, None; Maria Musolino, None;
Mauro Gacomini, None; Monica Bonetto, None; Paolo Fraccaro,
None; Carlo E. Traverso, None; Massimo Nicolò, None
Program Number: 1377 Poster Board Number: A0072
Presentation Time: 8:30 AM–10:15 AM
Trends in Patient Satisfaction During Transition to Electronic
Medical Records in the Pediatric Ophthalmology Clinic
Kara M. Cavuoto1, 2, Pedro Monsalve1, 2, Joyce C. Schiffman1, 2, Ta
C. Chang1, 2. 1Univ of Miami Sch of Medicine, Miami, FL; 2Bascom
Palmer Eye Institute, Miami, FL.
Purpose: The use of electronic medical records (EMR) has been
federally mandated since early 2014. We evaluated the impact of the
shift to EMR on patient satisfaction in a tertiary care center pediatric
ophthalmology practice.
Methods: Prospective, cross-sectional survey completed at three
time points: two weeks prior to (phase 1), two weeks after (phase 2),
and three months after (phase 3) transition to EMR. A questionnaire
consisting of ten Likert-type scaled questions assessing satisfaction
with two free response questions estimating wait time was completed
by a parent (or guardian) whose child (<18 years) was scheduled for a
pediatric ophthalmology visit. Satisfaction scores and wait times were
compared within each phase and across phases, as well as between
appointment types (new, follow up, preoperative, and postoperative).
Results: A total of 321 surveys were collected: 137 from phase 1, 55
from phase 2 and 129 from phase 3. The survey response rate was
91%, 84% and 94% for phase 1, 2 and 3 respectively. Of the total
visits, 63% were followups, 23% were new, 5% were preoperative
and 7% were postoperative. Overall patient satisfaction seemed to be
high in all phases without a statistically significant difference between
phases or types of appointment. Parent estimates of wait time were
longer in phase 1 than phase 2 (p=0.03), however not statistically
significant at other points. The wait time to see the physician
decreased from phase 1 to phase 2 (129 to 105 min), but increased at
phase 3 (139 min), so that phases 1 and 3 were similar (p=0.3). The
wait time and the time spent with the physician were longest for new
visits (156 and 50 min then followup (128 and 20 min), preoperative
(93 and 17 min) and postoperative (73 and 19 min) (p=<0.05). The
estimated time spent with the physician was longer in phase 2 than
phase 1 (p=0.0015) and in phase 3 than phase 1 (p=<0.001), however
the actual amount of time spent with the physician was similar (26 vs
30 vs 24 min) and not statistically significant (p=0.74).
Conclusions: The transition to EMR did not impact parent
satisfaction. In fact, parents perceived that the physician spent longer
with them after EMR implementation. The decrease in wait time in
phase 2 is likely due to an intentional reduction in clinical volume in
anticipation of the EMR learning curve with return to pre-EMR levels
as clinical volumes resumed normal levels.
Commercial Relationships: Kara M. Cavuoto, None; Pedro
Monsalve, None; Joyce C. Schiffman, None; Ta C. Chang, None
Program Number: 1378 Poster Board Number: A0073
Presentation Time: 8:30 AM–10:15 AM
An Eye Diagnostic Code for Evaluation of Ophthalmological
Abnormalities in Fetal Alcohol Syndrome Disorders
Eva M. Aring1, Magnus Landgren2, Leif Svensson2, Marita A.
Gronlund1. 1Ophthalmology, Neuroscience and Physiology,
Gothenburg, Sweden; 2Pediatrics, Skaraborg Hospital, Skövde,
Sweden.
Purpose: Fetal Alcohol Syndrome Disorders (FASD) are diagnosed
and divided into Fetal Alcohol Syndrome (FAS), Partial FAS
(PFAS), Static Encephalopathy Alcohol Exposed (SE/AE) and
Neurobehavioral Disorder Alcohol Exposed (ND/AE) according to
a 4-Digit Diagnostic Code which is used worldwide (http://depts.
washington.edu/fasdpn). There are no guidelines for examination of
the eye and the visual pathways in individuals with prenatal alcohol
exposure. We tested the hypothesis that the more severe FASD the
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
more ophthalmological abnormalities are found. Our purpose was
also to develop and evaluate an ophthalmological tool serving as
a complement to the method described above which evaluating
growth, central nervous system functions, developmental delay and
behavioral dysfunction as well as face characteristics in FASD.
Methods: Fifty children with a mean age of 7.6 years (range 4.9 to
10.4) were evaluated; 25 children (13 M, 12 F) with FASD and 25
age and sex matched controls. The four ophthalmological digits used
were: Visual acuity (VA), refraction, strabismus/binocular function
and structural abnormalities of the eye (Fig.). The magnitude of
expression of each feature is ranked independently on a 4-point
Likert scale with 1 reflecting normal ophthalmological findings and
4 reflecting a strong presence of the most common ophthalmological
abnormalities found in our children with FASD. Thus, code 4444
reflects the most severe expression of reduced VA, significant
refractive errors, manifest strabismus/defect binocular functions and
structural abnormalities of the eye. At the opposite end of the scale
code 1111 reflecting normal ophthalmological findings.
Results: 4-Digit Eye Diagnostic Code showing median score for
the different groups of FASD studied and controls as follows:
Study group; Visual Acuity; Refraction; Strabismus/Binocular
function; Structural Abnormalities;
FAS (n=9) 2 2 3 3; PFAS (n=6) 2 1 3 3; ND/AE (n=7) 2 1 3 3; SE/
AE (n=3) 1 1 2 1; CONTROLS (n=25) 1 1 1 1
Conclusions: Our results are in consistence with our hypothesis
that children with fully developed FAS have the highest score of
ophthalmological abnormalities. This tool, the 4-Digit Eye Diagnostic
Code, which is based on the most common ophthalmological
abnormalities found in these children, may serve as an diagnostic
help and further developed a guideline for what and when children
with FASD should be examined and followed-up.
Commercial Relationships: Eva M. Aring, None; Magnus
Landgren, None; Leif Svensson, None; Marita A. Gronlund, None
Support: Agreement conserning research and education of doctors
(ALFGBG-11626, ALFGBG 211671, ALFGBG 445021),Sweden
Program Number: 1379 Poster Board Number: A0074
Presentation Time: 8:30 AM–10:15 AM
Lack of government-funded optometric services is associated
with reduced utilization of eye care providers and increased
utilization of family doctors
Yaping Jin1, 2, Richard Wedge3, Sherif El-Defrawy1, John G.
Flanagan4, Yvonne M. Buys1, Graham E. Trope1. 1Ophthalmology
& Vis Sci, University of Toronto, Toronto, ON, Canada; 2Dalla
Lana School of Public Health, University of Toronto, Toronto, ON,
Canada; 3Health PEI, Charlottetown, PE, Canada; 4University of
Waterloo, Waterloo, ON, Canada.
Purpose: Canadian optometric eye care services are inconsistently
funded by provincial governments. We investigated whether lack
of provincial government-insured optometric services is associated
with unequal patient utilization of optometrists, ophthalmologists and
family doctors.
Methods: We compared the utilization of eye care providers (i.e.
optometrists and ophthalmologists) and family doctors among
Caucasians residing in provinces with and without governmentinsured optometric services. Derived data was based on self-reports
from the Canadian Community Health Survey 2005 (n=132,221)
collected by Statistics Canada. Optometrists and ophthalmologists
were combined together because the survey question did not
distinguish between them. Given the small sample size of nonCaucasians, they were excluded in order to make valid comparisons.
Results: Among Caucasians without known eye disease, the
utilization of eye care providers was lower in provinces with
uninsured provincial optometric services (33.5%) versus provinces
with government-insured optometric services (38.2%, p<0.05).
Larger differences were found for people aged 12-17 (38.5% vs
47.7%, p<0.05) and 65+ (38.1% vs 51.5%, p<0.05).
Among people aged 12 years and older who did not have a chronic
condition and used an eye care provider in a 12-month period (i.e.
they had an eye care need), 76.0% also used a family doctor if they
resided in provinces with uninsured optometric services, compared
to 70.2% (p<0.05) in provinces with government-insured optometric
services. For those who did not have a chronic condition and did not
use an eye care provider (i.e. they did not seem to have an eye care
need), the utilization of a family doctor was 62.6% for uninsured
provinces versus 61.6% for insured provinces (p>0.05). These results
suggest that uninsured people with a vision concern are more likely
to visit a family doctor rather than an optometrist. In both univariate
and multivariate analyses, we observed about 5% (p<0.05) increased
utilization of family doctors in the provinces with uninsured
optometric services.
Conclusions: Lack of government-funded optometric services
is associated with reduced utilization of eye care providers and
increased utilization of family doctors. This is likely due to financial
barriers inhibiting access to optometrists in provinces without insured
optometric services.
Commercial Relationships: Yaping Jin, None; Richard Wedge,
None; Sherif El-Defrawy, None; John G. Flanagan, None; Yvonne
M. Buys, None; Graham E. Trope, None
Support: CIHR HRA 126901
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 1380 Poster Board Number: A0075
Presentation Time: 8:30 AM–10:15 AM
Eye health and access to eye care among migrant farmworkers in
Georgia
Rebecca Russ1, Michael Rothschild1, Jinan Saaddine2, Lindsay
Collin3, Danny Haddad1. 1Ophthalmology, Emory University School
of Medicine, Atlanta, GA; 2National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and
Prevention, Atlanta, GA; 3Rollins School of Public Health, Emory
University, Atlanta, GA.
Purpose: Little is known about vision loss and eye health safety in
migrant farmworkers in the United States. The purpose of this study
was to assess risk factors for eye diseases, visual impairment and
other eye symptoms, use of protective eyewear, and access to eye
care among migrant farmworkers.
Methods: A cross-sectional study was performed with survey
questions from the Behavioral Risk Factor Surveillance System
(BRFSS) and National Health Interview Survey (NHIS). Participants
(n=162) were migrant farmworkers 18+ years working in agricultural
camps throughout Lowndes County, Georgia, recruited from a
primary care clinic. Outcome measures included risk factors for eye
diseases, visual impairment, eye discomfort, eye injury, and access to
eye care. SAS software was used to analyze frequency distributions
and perform chi-square test for associations.
Results: Mean age was 32.2 ±10.5 years, 81.5% were male, and
91.4% were Spanish-speaking. One-third (34.0%) had ever-smoked
and 25.2% are current smokers, 8.3% reported having diabetes,
and 80.9% reported never or rarely using protective eyewear when
working in agriculture. 5.7% and 8.0% reported difficulty with far
and near vision. In all, 8.0% reported having an eye injury at their
work place, which caused them to lose at least one day of work, and
16.7% reported moderate to severe eye irritation. 46.6% reported
never having had their eyes examined by a doctor, while 32.9%
report their last eye exam was two or more years ago. Of those with
diabetes, 33.3% have never seen an eye doctor. The most common
reasons for not having an eye exam included cost and not wanting to
miss work. 77.2% did not have general health insurance, and 92.6%
did not have eye insurance. One-fifth (19.9%) were unable to afford
glasses. Odds of injury in those seen by an eye doctor within two
years was 2.9 times the odds in those unseen (95% CI 0.87-9.53,
p=0.07).
Conclusions: This study provides an important assessment of
eye health in an understudied and largely underserved population.
Despite multiple risk factors and a substantial prevalence of
visual impairment, eye irritation, and eye injury, 79.5% of migrant
farmworkers have not seen an eye doctor within the past two-years.
Access to eye care is greatly limited by affordability and lack of
insurance. Concerted efforts are needed to improve understanding,
detection, treatment, and prevention of eye disease and injuries in
migrant farmworkers.
Commercial Relationships: Rebecca Russ, None; Michael
Rothschild, None; Jinan Saaddine, None; Lindsay Collin, None;
Danny Haddad, None
Program Number: 1381 Poster Board Number: A0076
Presentation Time: 8:30 AM–10:15 AM
Improving eye care for people with dementia: lessons for
optometric practice
Michael Bowen1, Beverley Hancock1, David Edgar2, Rakhee Shah1.
1
Research, College of Optometrists, London, United Kingdom; 2City
University, London, London, United Kingdom.
Purpose: To explore and describe barriers to, and ways of improving,
eye care for people with dementia.
Methods: Qualitative study. Focus groups, five with family carers
and five with optometrists, were used to explore experiences of
and attitudes towards eye care for people with dementia. Data were
analysed using framework analysis to identify recurring themes
and highlight differences or consistencies among participants and
between groups.
Results: Participants, both family carers of people with dementia
and optometrists, displayed a range of attitudes and awareness of the
importance of eye care for people with dementia. While some carers
had good experiences of eye examinations, others reported a lack of
practitioner understanding of how to deal with people with dementia;
optometrists similarly varied in their confidence in dealing with this
patient group. Balancing the demands of optometric testing and the
possibility of causing distress versus quality of life was a key ethical
issue for both parties. This was reflected in concerns around problems
reported in persuading patients to wear prescribed eye wear and the
appropriateness of cataract surgery.
Conclusions: Recommendations arising from the study included:
more frequent eye examinations; more communication between
the optometrist and the main carer; greater use of domiciliary
testing; and earlier referral for cataract surgery. HS&DR Funding
Acknowledgement: This project was funded by the National
Institute for Health Research Health Services and Delivery Research
Programme (project number 11/2000/13). Department of Health
Disclaimer: The views and opinions expressed therein are those
of the authors and do not necessarily reflect those of the HS&DR
Programme, NIHR, NHS or the Department of Health.
Commercial Relationships: Michael Bowen, None; Beverley
Hancock, None; David Edgar, None; Rakhee Shah, The Outside
Clinic (E)
Support: UK NIHR Health Services and Delivery Research Grant 11/2000/13
Program Number: 1382 Poster Board Number: A0077
Presentation Time: 8:30 AM–10:15 AM
Professional storage of clinical biosamples for eye diseases: the
CORRBI biobank
Magda Meester1, 2, Johannes R. Vingerling1, Netty Dorrestijn3,
Caroline C. Klaver1, 4, L I. Van Den Born2, 3. 1Ophthalmology,
Erasmus Medical Center, Rotterdam, Netherlands; 2The Rotterdam
Eye Hospital, Rotterdam, Netherlands; 3Rotterdam Ophthalmic
Institute, Rotterdam, Netherlands; 4Epidemiology, Erasmus Medical
Center, Rotterdam, Netherlands.
Purpose: Biobanks are becoming more and more common use in
clinical medicine. The implementation, management, storage, as well
as safeguarding of (clinical) data can be challenging for individual
institutes. Here, we describe the ophthalmic biobank CORRBI from
the Netherlands as an example of how a clinical biobank can be put
into operation.
Methods: CORRBI was founded in 2012 as a collaboration between
two large ophthalmic centers in Rotterdam with the objective to
provide storage of biomaterials of ophthalmic patients for future
research. Ethical approval for CORRBI was obtained from the local
academic medical ethical committee. Clinicians ask eligible patients
during their clinic for participation in the biobank. Patients are
subsequently informed on the ethical issues regarding storage and use
of samples for scientific purposes by a nurse or research assistant, and
sign informed consent. Draw of biomaterials such as DNA and serum
occurs at the blood draw unit; waste biologic samples of anterior
or posterior chamber fluid are obtained at the OR during surgery.
Data on ethnicity, family composition, and lifestyle are obtained by
questionnaire; ophthalmic data are obtained from medical charts.
Samples are stored using standard protocols, and unique biobank
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
numbers and data are registered in an online, secured database.
Requests for use of samples are judged by the biobank committee
consisting of members from both institutes, and approval for use is
only granted if the ophthalmologist that collected the sample set of
interest agrees.
Results: CORRBI now stores 3750 samples from 2950 patients. A
variety of ophthalmic disorders is represented, ranging from common
disorders such as myopia, glaucoma, uveitis, strabismus, and agerelated macular degeneration to rare disorders such as optic nerve
head drusen (ONHD) and AZOOR. Samples include DNA (75%),
serum (12%), and other specimens (13%). Samples from CORRBI
have contributed to international research initiatives such as exome
sequencing projects for AMD and glaucoma.
Conclusions: The CORRBI biobank has proven to be an efficient
platform for storage of biomaterials and clinical data of a wide range
of ophthalmic disorders, and is an example of how a biobank can be
instrumental between the clinic and research.
Commercial Relationships: Magda Meester, None; Johannes R.
Vingerling, None; Netty Dorrestijn, None; Caroline C. Klaver,
None; L I. Van Den Born, None
Support: Combined Ophthalmic Research Rotterdam grant 1.2.0
Program Number: 1383 Poster Board Number: A0078
Presentation Time: 8:30 AM–10:15 AM
Utilization of Ophthalmology-Specific Emergency Department
Services: A Prospective Study
Daniel Gologorsky, Joyce C. Schiffman, Luz Ajuria, James Banta.
Ophthalmology, Bascom Palmer Eye Institute, Miami, FL.
Purpose: To describe utilization trends at an ophthalmology-specific
emergency department.
Methods: This is a prospective study involving a survey completed
by the physician at the end of each new patient visit at the Bascom
Palmer Eye Institute emergency department. The survey was included
in the chart of every new patient presenting to the emergency
department for a 1-month period each year from 2010-2014. The
study included 5,325 surveys completed by treating staff and
physicians during the study period. Surveys included information
on the date, time of day, patient age and gender, duration of
symptoms, insurance status, preliminary diagnosis, time to followup appointment, and whether the physician considered the visit an
ophthalmic emergency. All data were analyzed using student’s t-test
and Pearson chi-squared test.
Results: An average of 45.6 new patients per day (range 26-63)
presented to the emergency department. Most common diagnoses
included viral conjunctivitis (9.2%), dry eye syndrome (7.2%), and
corneal abrasion (5.9%). Non-emergent visits accounted for 32.8% of
visits. Female patients and patients with age of 65 years or older were
statistically more likely to present with non-emergencies (p < 0.001).
Patients presenting on the weekend were significantly more likely to
be presenting with an ophthalmic emergency than those presenting
during weekdays (74.1% versus 65.6%, p < 0.001). Patients insured
under the regional public assistance program were more likely to
present with non-emergencies than patients of all other insurance
statuses (p < 0.001). Patients with symptom duration of greater than 1
week were significantly more likely to present with non-emergencies
(p < 0.001).
Conclusions: Over one-third of new patient visits to the emergency
department were non-emergent. Factors predictive of non-emergent
patient visits were female gender, age of 65 years or older, duration
of symptoms greater than one week, weekday visits, and regional
public assistance insurance.
Table: Most common diagnoses presenting to BPEI ED during the
study period
Commercial Relationships: Daniel Gologorsky, None; Joyce C.
Schiffman, None; Luz Ajuria, None; James Banta, None
Program Number: 1384 Poster Board Number: A0079
Presentation Time: 8:30 AM–10:15 AM
Prospective study about activity of emergency unit in the
Department of Ophthalmology (Nancy, University Hospital,
France)
Audrey Baudot, Francois Ameloot, Oualid Guechi, Karine ANGIOI.
university hospital center, Gondreville, France.
Purpose: Ophthalmological emergencies are common. Actually,
access to care is difficult because of the low medical demography.
The Department of Ophthalmology (Nancy, University Hospital,
France) created a unit devoted to emergency in 2012.
Methods: We conducted a cross sectional study to describe this
activity. All consecutive patients seen in the unit were included from
February to April 2012 and from October to December 2014.
We used a standardized evaluation (age, sex, access to care,
geographic origin, symptoms, diagnosis, treatment, patient outcome).
Every physician considered the real nature of the emergency.
Results: 1496 patients were included during the first period (series
1) and 1116 during the second (series 2). The most common patient
was a 45 years old man (55.3% and 56.3%). Many patients came by
themselves without medical advice (40.1% and 58.4%). Principal
symptoms were redness (31.5% and 24.8%), pain (28.5% and
25.0%), visual loss (22.6% and 17.7%), and irritation (20.6% and
17.8%). Traumatic context was frequent (about 25.0% of patients).
The most prevalent diagnosis concerned the cornea. Serious
infectious condition and vascular diseases were rare. 5.0% of patients
were hospitalized and 6.0% received surgical treatment. 62.7% of
them benefited only one consultation in emergency. They did not
need another clinical control. 62.1% to 63.1% of consultations were
qualified as real emergency.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Conclusions: Actually, the management of ophthalmic emergencies
is a real public health problem. It is important to train emergency
physicians and general practitioners, to address wisely to the
specialist. Structures such as our unit seem to be an effective way to
access care.
Commercial Relationships: Audrey Baudot, None; Francois
Ameloot, None; Oualid Guechi, None; Karine ANGIOI, None
Program Number: 1385 Poster Board Number: A0080
Presentation Time: 8:30 AM–10:15 AM
Review and characterization of ophthalmology inpatient and
emergency room consultations at a tertiary care hospital
Andrew A. Kao, Anita Gupta. Ophthalmology, The New York Eye
and Ear Infirmary, New York, NY.
Purpose: To identify the pattern and frequency of inpatient and
emergency department ophthalmology consultations at a large tertiary
care hospital.
Methods: A retrospective chart review of all inpatient ophthalmology
consult notes from 6/1/2013 to 12/31/13 was conducted. Patient
age, gender, consulting service, type of consultation (inpatient vs
emergency department), chief complaint, visual acuity, and final
diagnosis were recorded.
Results: There were a total of 299 consults seen. The average age
of the patients was 46.75 years (range 2 days to 100 years). There
were 162 males and 137 females. There were 156 inpatient consults
and 143 emergency room consults. The most frequent consulting
service was the emergency department (131 consults), followed by
internal medicine (65). The most common chief complaint was blurry
or decreased vision (49 consults), followed by trauma, eye pain, red
eye, and baseline examination prior to starting ethambutol therapy.
The most common diagnosis was orbital wall fracture (25 patients),
followed by corneal abrasion, dry eye, subconjunctival hemorrhage,
conjunctivitis, and preseptal cellulitis.
Conclusions: This study profiles the typical patient and eye
problem that may be encountered when requested for a consult.
Ophthalmologic consultation is a valuable inpatient consultation
service that may make a significant difference in the management of
patients at an inpatient hospital. Education of internal medicine and
emergency room doctors about the most common eye complaints and
findings may facilitate and expedite patient care.
Commercial Relationships: Andrew A. Kao, None; Anita Gupta,
None
Program Number: 1386 Poster Board Number: A0081
Presentation Time: 8:30 AM–10:15 AM
Does a patient’s time of presentation correlate with the severity of
diagnosis? – The experience of the Ophthalmology Urgent Care
center at the New York Eye and Ear Infirmary
Luna Xu1, Aimee Chang2, Kellie Gergoudis2, Anita Gupta1.
1
Ophthalmology, New York Eye and Ear Infirmary, New York, NY;
2
Mount Sinai Medical Center, New York, NY.
Purpose: The study aims to explore whether there is an association
between the severity of an ophthalmologic diagnosis and the time at
which a patient presents to an ophthalmology urgent care center.
Methods: The medical records of all patients who presented to
the New York Eye and Ear Infirmary Ophthalmology Urgent Care
Center in July 2014 were reviewed. Data recorded included the time
of presentation, gender, age, and principle diagnosis. The presenting
time were separated into four categories: Period 1: weekday 7am
to 3pm, Period 2: 3pm to 11pm, and Period 3: 11pm to 7am next
day, and Period 4: weekends/holidays. The principle diagnosis were
categorized into four severity levels. Level 1: management of chronic
symptoms; Level 2: acute symptoms, not vision threatening; Level 3:
acute symptoms, potentially vision threatening; level 4: emergency
situations, acute intervention required (Table 1).
Results: A total of 708 patients presented to ophthalmology urgent
care in July 2014, of which 373 (52.7%) were women. The average
age of patients were 44 years old in both genders. There were 129,
281, 31, and 267 patients who presented in time Periods 1, 2, 3,
and 4, respectively. In terms of severity of diagnosis, there were 63,
323, 260, and 43 patients in diagnosis severity Levels 1, 2, 3, and 4.
In time Period 1, the average severity level was 2.4. In Period 2, it
was 2.5. In Period 3 and 4, they were 2.4 and 2.3, respectively. The
majority of patients (548 patients, 77.4%) presented during after work
hours (Period 2) and weekends (Period 4). There is no significant
correlation between the time at which a patient presents and the
severity of one’s diagnosis (Chi Square, Χ2 = 0. 33). In addition, male
patients tend to present with more severe diagnosis (Χ2 = 0. 02) and
during weekdays (Χ2 = 0. 02) respectively.
Conclusions: The time at which a patient presents to an
ophthalmology urgent care does not significantly correlate with
the severity of his/her diagnosis. On the other hand, the gender of
the patient may be more closely related to the presenting time and
diagnosis severity.
Commercial Relationships: Luna Xu, None; Aimee Chang, None;
Kellie Gergoudis, None; Anita Gupta, None
Program Number: 1387 Poster Board Number: A0082
Presentation Time: 8:30 AM–10:15 AM
Patients ‘ and health professionals’ perceptions of the ophthalmic
patient experience: motives, barriers and expectations
Derek Huang, Jason Bacharach. Ophthalmology, California Pacific
Medical Center, Winnetka, CA.
Purpose: The purpose of this study is to determine patients’ attitudes
towards their experience in a physician’s practice and to correlate
those attitudes with the physicians’ perceptions of the patients
experience in an ophthalmology setting. One particular facet of
this study examines the importance of technology in a patient’s
experience at a physician’s practice. Further by understanding factors
that patient’s emphasize or seek in a practice, physicians can better
accommodate the changing needs of patients. Defining the factors
that influence a patient’s interest in ophthalmology and delineating
what patients value in an ophthalmology practice allow physicians to
better accommodate the changing needs of patients.
Methods: A descriptive survey was distributed to patients and
physicians of an ophthalmologic private practice in Northern
California.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Results: 31 patients completed the survey and 6 physicians in a
single Northern California ophthalmic private practice. Results
showed that the most important factors for patients and physicians
are the ability to ask questions, cleanliness, staff friendliness and
availability of the physician.
Patients would like a physician’s social media to be a reference for
their practice and there is a split to social media acting as a means
of physician-patient communication as well as a resource for health
related topics. Physicians felt that social media should be a means of
marketing and promotion of the practice but none thought it should
be used as a tool for direct patient interaction.
Patients do use social media to find information related to their health
conditions, though the near majority is on a monthly level. Patients
overwhelmingly felt the health information from their physician to be
very reliable over the information found via social media.
Conclusions: Patients value the ability to ask questions and be
heard. The overall patient experience is important: wait times/staff
friendliness/cleanliness/availability of the physician. Less emphasis is
placed on social media and a physician’s presence on social media.
In terms of social media; no physician felt that social media should be
a tool for direct patient interaction but rather a majority felt it is a tool
for marketing and promotion of the practice.
Patients’ perceptions on the role of social media on a physician’s
practice
Patients’ Social Media Usage
Commercial Relationships: Derek Huang, None; Jason
Bacharach, None
Program Number: 1388 Poster Board Number: A0083
Presentation Time: 8:30 AM–10:15 AM
Prevalence of ophthalmic diagnoses among hospital admissions in
the Nationwide Inpatient Sample
Craig S. Schallhorn1, Frank M. Bishop2, Natalie A. Afshari3. 1School
of Medicine, University of California, San Diego, La Jolla, CA;
2
Department of Ophthalmology, Naval Medical Center San Diego,
San Diego, CA; 3Shiley Eye Center, University of California, San
Diego, La Jolla, CA.
Purpose: To examine changes in prevalence of ophthalmic diagnoses
among hospital admissions in a large administrative database
Methods: Retrospective analysis using the Nationwide Inpatient
Sample for years 2000-2012. Inclusion criteria were ICD-9 diagnosis
codes of ophthalmic disease. Primary outcome was annual change in
prevalence of ophthalmic diagnoses during the study period. Patient
demographic factors and comorbidities were included for analysis.
Results: A total of 1945312 hospital admissions with associated
ophthalmic diagnoses were captured for analysis. The population
was 45% male, median age 70 (54-82), 68% white, 97% insured.
The majority of the study group presented ophthalmic diagnoses
as comorbid conditions, not primary admission diagnoses. Most
common ophthalmic diagnoses were glaucoma (0.87% of all
admissions), diabetic retinopathy (0.44%), conjunctivitis (0.18%),
cataract (0.14%), and orbital fracture (0.10%). An increasing
prevalence of ophthalmic conditions over the study period was
observed in 12/24 of diagnoses, including cataract, conjunctivitis,
corneal abrasion, glaucoma, herpes simplex keratitis, herpes zoster
ophthalmicus, keratitis, optic neuritis, orbital fracture, primary
malignancy of eye, retrobulbar hemorrhage, and strabismus. A
decreasing prevalence was observed in 6/24, including chorioretinitis,
corneal ulcer, hyphema, open globe, retinal detachment, and
vitreous hemorrhage. A stable trend was observed in 6/24, including
angle closure glaucoma, diabetic retinopathy, endophthalmitis,
ischemic optic neuropathy, orbital cellulitis, and uveitis. Most
common primary admission diagnoses within the study group were
pneumonia, heart failure, and coronary artery disease. Comorbid
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
diagnoses frequent in the study were hypertension, diabetes mellitus,
and hyperlipidemia.
Conclusions: Over the study period, half of ophthalmic diagnoses
increased in prevalence among hospital admissions; the rest
demonstrated stable or decreasing prevalence. The increasing
prevalence of ophthalmic diagnoses observed may reflect an aging
population with systemic disease at risk for hospital admission.
Future study will delineate additional factors that influence
prevalence, such as cost and treatment patterns. The main limitation
of this study is that inpatient ophthalmic diagnoses were principally
comorbid conditions, not primary admission diagnoses.
ophthalmic diagnosis, medical diagnosis, service requesting
consultation, and ophthalmologic interventions were recorded. A twosample test was used to compare pediatric consults to adult inpatient
consults seen at Northwestern Memorial Hospital. P-values < 0.05
were considered significant.
Results: 426 new inpatient consultations were requested from
the pediatric ophthalmology service. The most common reasons
for consultations were to evaluate for papilledema (24.12%), to
participate in the work-up of an unknown systemic disease (11.0%),
to evaluate for non-accidental trauma (7.96%), and to evaluate
eye redness (5.15%). Intracranial mass lesions (10.65%) and
hydrocephalus (7.79%) were the most frequent primary medical
diagnoses. The most common ophthalmology diagnoses were optic
disc edema (6.56%), orbital or preseptal cellulitis (4.46%), and retinal
hemorrhages (2.58%).
Blurred vision was a more common reason for consultation in the
adult population than pediatric population (14.8% vs 3.5%, p <
0.0001). Evaluation for papilledema was a more common reason
for consultation in the pediatric population (24.1% vs 3.3%,
p<0.001). Optic disc edema was found more often in children than
adults (6.56% vs 1.5%, p< 0.0001). Regarding the primary medical
diagnoses, the pediatric population had more trauma (5.71% vs
1.5%) and hydrocephalus (7.79% vs 1%) than the adult population
(p<0.0001 for both).
Conclusions: Pediatric inpatient ophthalmology consultations
address a variety of pathologies. Our results demonstrate differences
between the characteristics of consultations at a tertiary adult hospital
compared to a tertiary children’s hospital. Physicians at teaching
hospitals can incorporate this data to optimize patient care and
to improve the training curriculum for ophthalmology and nonophthalmology housestaff.
Annual change in prevalence of ophthalmic diagnoses
Commercial Relationships: Craig S. Schallhorn, None; Frank M.
Bishop, None; Natalie A. Afshari, None
Support: UCSD Vision Research core grant P30EY022589
Program Number: 1389 Poster Board Number: A0084
Presentation Time: 8:30 AM–10:15 AM
Inpatient Pediatric Ophthalmology Consults at a Tertiary Care
Children’s Hospital
Radha Ram1, 2, Eduardo Bustamante1, 2, David Sharrah1, 2, Hannah
Palac1, Marilyn Mets2, Nicholas J. Volpe1, Rebecca MetsHalgrimson2. 1Ophthalmology, Northwestern University, Feinberg
School of Medicine, Chicago, IL; 2Ophthalmology, Ann and Robert H
Lurie Children’s Hospital of Chicago, Chicago, IL.
Purpose: Pediatric ophthalmology consultation is requested to
diagnose and treat a variety of conditions in tertiary care children’s
hospitals. The goals of this study were to review inpatient
consultations performed at a tertiary care children’s hospital and to
compare the frequency, type, and results of previously described adult
inpatient consults to those of pediatric inpatient consults.
Methods: Health records of inpatients seen by the ophthalmology
service at Lurie Children’s Hospital between July 1, 2013 and June
30, 2014 were retrospectively reviewed. Reason for consultation,
Commercial Relationships: Radha Ram, None; Eduardo
Bustamante, None; David Sharrah, None; Hannah Palac, None;
Marilyn Mets, None; Nicholas J. Volpe, None; Rebecca MetsHalgrimson, None
Support: Research to Prevent Blindness
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 1390 Poster Board Number: A0085
Presentation Time: 8:30 AM–10:15 AM
Survey of referrals and medical reports in optometric practices
in Norway: Preliminary findings of a 3-year prospective internetbased study
Per O. Lundmark1, Knut Luraas2, Per Kristian Knudsen3, Oyvind
Krogh4. 1Optometry and Visual Science, Buskerud and Vestfold
University College, Kongsberg, Norway; 2Rjukan Synssenter
Optometri, Rjukan, Norway; 3Norwegian Association of Optometry,
Oslo, Norway; 4Krogh Optikk Ski, Ski, Norway.
Purpose: The increasing demand for primary eye care due to an
ageing population implicates an enhanced role of optometrists in the
communities. However, there is limited knowledge about the extent
of interdisciplinary cooperation between optometrists and other
health care professionals. The primary objective of this prospective
survey was to investigate the rate of referrals and returning medical
reports between optometrists and other health professionals in
Norway. Secondary objectives were to investigate the extent of
optometric follow-ups and the use of diagnostics drugs.
Methods: The study is an ongoing prospective electronic survey
administered on internet between Nov. 2014 and Dec. 2017.
Eligible are optometrists in private optometric practice in Norway.
Participants register data for one year. The survey uses a protected
web-site for registration of: i) examinations and the use of
diagnostics; ii) referrals, incl. receiving health care professionals,
diagnoses and ICPC-2 codes; iii) medical reports, incl. ICD-10
codes, and iv) optometric follow-ups, incl. completion of preceding
referrals. Analysis of agreement between diagnoses in referrals
and reports is made possible by encoding patients’ id. Compliance
is promoted through reminder systems and access to customized
statistics and reports. The study is approved by the Regional
Committees for Medical and Health Research Ethics and the
Norwegian Social Science Data Services.
Results: 1 month into the study, 11 optometrists were included (F:
5, mean age 41.3 yrs) in a first batch of recruitment. There were
670 registered eye examinations, 190 contact lens examinations
and 72 auxiliary examinations. Diagnostic drugs were used in 4 %
of these. There were 48 registered referrals, all to ophthalmologists
(84 % in private practice). Top 3 diagnoses were cataract (40 %),
glaucoma (8 %) and AMD (6 %). Diagnostic drugs were used in 31
% of the examinations leading to a referral. In the same period there
were 10 returned medical reports and 1 follow-up. 4 of the medical
reports were linked with registered referrals. All with corresponding
diagnoses.
Conclusions: These are the first published results from a nationwide
prospective survey of referrals and medical reports in optometric
practice in Norway. Early results indicate a predominant direction of
clinical information from optometrists to ophthalmologists.
Commercial Relationships: Per O. Lundmark, None; Knut
Luraas, None; Per Kristian Knudsen, None; Oyvind Krogh, None
Program Number: 1391 Poster Board Number: A0086
Presentation Time: 8:30 AM–10:15 AM
Monocular precautions counseling
Neil Farbman, Wayne Cornblath. Kellogg Eye Center, Ann Arbor,
MI.
Purpose: It is strongly advised that patients with decreased or no
vision in one eye wear spectacles with 3mm polycarbonate lenses
and a safety frame at all times to protect the better-seeing eye. It is
the responsibility of ophthalmologists and optometrists to counsel
patients regarding these precautions. The purpose of this study is to
determine how frequently this counseling occurs and is documented,
as well as what factors influence whether it occurs.
Methods: We conducted a retrospective chart review of patients who
underwent enucleation or evisceration at UMHS during a specified
period. We reviewed all encounters for each patient, both before and
after surgery. Statistical significance was calculated using chi square
and Fisher exact tests.
Results: We identified 39 patients and reviewed 342 encounters.
Patients met our criteria for monocular or significantly asymmetric
visual acuity (≤20/70 in the worse eye, >20/70 in the better eye) at
324 encounters. Monocular precautions counseling was documented
at 78 encounters. Ten patients never received counseling at any
encounter. Factors that increased the probability of counseling to a
statistically significant degree include worse visual acuity, history
of enucleation or evisceration (versus asymmetrical visual acuity
prior to surgery), being seen by a fellow or resident in addition to an
attending physician, specialty being seen (glaucoma and oculoplastics
services most likely to document monocular precautions counseling),
white race, and encounter occurring after implementation of
electronic health records. Sex and laterality of the worse eye were
not statistically significant factors. Age was also not statistically
significant, although there was a trend toward greater probability of
counseling with increasing decade of life (p = 0.14).
Conclusions: Eye care providers frequently fail to counsel patients
on monocular precautions (or at least to document this conversation).
Whether counseling takes place depends both on provider factors
(specialty, level of training, use of electronic health records) and
patient factors (visual acuity, history of enucleation or evisceration,
race). Failure to counsel monocular patients puts these patients
at increased risk of blindness and exposes eye care providers to
potential liability should a devastating injury cause significant
vision loss in the better eye. Future studies should evaluate whether
interventions can increase the rate at which counseling takes place.
Commercial Relationships: Neil Farbman, None; Wayne
Cornblath, None
Program Number: 1392 Poster Board Number: A0087
Presentation Time: 8:30 AM–10:15 AM
Improving Patient Education Materials about Glaucoma with
Attention to Low Health Literacy
Andrew M. Williams1, 2, Jullia A. Rosdahl2, Kelly W. Muir2. 1Michigan
State University College of Human Medicine, Grand Rapids, MI;
2
Ophthalmology, Duke Eye Center, Durham, NC.
Purpose: Poor health literacy is associated with worse health-related
outcomes in glaucoma. We revised our department’s glaucoma patient
education materials using evidence-based guidelines about writing
for patients with low health literacy. The purpose of this study was
to assess whether our revisions improved the handouts’ suitability
for a low health literacy population using a validated scoring tool for
patient education materials.
Methods: Evidence-based guidelines for writing easy-to-read patient
education materials were applied to revise 12 patient education
handouts on various glaucoma topics that are commonly distributed
at our academic glaucoma practice. The original and revised versions
of the handouts were scored in random order by two glaucoma
specialists. Handouts were scored using the Suitability Assessment
of Materials (SAM) instrument, which systematically assesses the
suitability of health information materials for patients with low
health literacy. The Flesch-Kincaid Grade Level (FKGL) was also
calculated for the original and revised documents. Paired t test was
used for analysis.
Results: SAM scores between the two evaluators were significantly
correlated (p<0.01, n=24). The mean (± standard deviation) SAM
score improved from 60±7% (adequate) for the original versions
(n=12) to 88±4% (superior) for the revised handouts (n=12)
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
(p<0.00001). Eleven of the 17 SAM criteria significantly improved
after revision, including: making the purpose evident, focusing
content on behaviors, inclusion of a summary, reading grade level,
use of active voice, use of common vocabulary, layout, typography,
use of subheadings, improving motivation by subdividing tasks,
and matching logic, language, and experience to the intended reader
(p<0.05 for all). Readability improved from an average of a tenthgrade reading level (FKGL=10.0±1.6) to a sixth-grade reading level
(FKGL=6.4±1.2) upon document revision (p<0.00001).
Conclusions: By revising our glaucoma handouts using guidelines on
writing easy-to-understand material, the suitability of the documents
for patients with low health literacy improved. The average reading
level decreased from the tenth-grade level to the sixth-grade level
after revision. A similar systematic approach could improve the
readability of other ophthalmic educational materials. Future research
could examine how improved materials affect clinical outcomes.
Commercial Relationships: Andrew M. Williams, None; Jullia A.
Rosdahl, None; Kelly W. Muir, None
Program Number: 1393 Poster Board Number: A0088
Presentation Time: 8:30 AM–10:15 AM
Interventions for Improving Pedagogic Outcomes in
Ophthalmology and Paraophthalmic Education: a scoping
systematic review
Michael A. Williams1, Mairead Boohan1, Allen Thurston2. 1Centre for
Medical Education, Queen’s University of Belfast, Belfast, United
Kingdom; 2Centre for Effective Education, Queen’s University of
Belfast, Belfast, United Kingdom.
Purpose: The prevalence of vision problems and their impact on
quality of life make them an important public health problem.
Effective education of relevant professionals underpins provision
of quality eye health care. This scoping systematic review had two
aims: firstly to investigate the extent and nature of scholarly output
published on ophthalmic and paraophthalmic education, specifically
to determinine what proportion consisted of randomized controlled
trials (RCTs), and secondly to assess the quality of reporting of any
RCTs identified.
Methods: The ‘Preferred Reporting Items for Systematic Reviews
and Meta-Analyses’ (PRISMA) (http://www.prisma-statement.org/
index.htm accessed August 2014) guidelines were used as a guide for
the conduct and report of this review. A search strategy was applied
to Pubmed. Any scholarly publications meeting predefined eligibility
criteria were selected. Predefined data were extracted on the category
of publication, and for RCTs on the study characteristics, quality of
reporting according to CONSORT guidelines, and the relevant effect
size.
Results: The initial search identified 2188 studies, of which 255
were relevant. The most common type of scholarly publication was a
description of an educational innovation, followed by opinion pieces
and descriptive studies (i.e. collecting data at one point in time).
RCTs made up 5.5% of the sample. Most of the 14 RCTs failed to
report most of the items recommended in the CONSORT guidelines.
Effect sizes could not be calculated for 9 of the 14 RCTs due to
relevant data not being reported, and for 4 of the 5 others, the effect
sizes had large confidence intervals.
Conclusions: Although clinicians regard RCTs as providing a high
quality level of evidence, in ophthalmic educational research there
are several reasons why RCTs are not often chosen as a study design.
Although this review only used one database and author, as a scoping
review it should provoke discussion on the value on non-RCT
designs to answer questions on ophthalmic educational practice,
but also highlight the need for investigators, ethical committees and
journals to insist on a better quality of RCT conduct than is presently
apparent in the ophthalmic educational literature.
Commercial Relationships: Michael A. Williams, None; Mairead
Boohan, None; Allen Thurston, None
Program Number: 1394 Poster Board Number: A0089
Presentation Time: 8:30 AM–10:15 AM
Assessing Geographic Variability in Rates of Strabisumus among
Children on Medicaid in Michigan and North Carolina
Paul P. Lee1, Joshua D. Stein1, Rebecca Anthopolos2, Joshua Tootoo2,
Christopher A. Andrews1, Marie Lynn Miranda2. 1Ophthalmology and
Visual Sciences, University of Michigan, Ann Arbor, MI; 2School of
Natural Resources, University of Michigan, Ann Arbor, MI.
Purpose: To determine spatial variability in the rate of strabismus
diagnosis among children enrolled in Medicaid in two US states.
Understanding geographic variation illustrates issues in disparities
and can improve the delivery of care.
Methods: Children age ≤10 enrolled in Medicaid in Michigan
and North Carolina during 2009/2010 were identified from the
Medicaid Analytic Extract (MAX) health care claims database.
Residential location for each child was determined by last known 5
digit zip code, connected to a Zip Code Tabulation Area (ZCTA) for
georeferencing and spatial analysis. ICD-9-CM billing codes were
used to identify children diagnosed with strabismus (code 378.xx).
Bayesian hierarchical intrinsic conditional autoregressive (ICAR)
spatial probit models were used to model the prevalence across
the Lower Peninsula of Michigan and the Raleigh-Durham-Cary
Combined Statistical Area (CSA). Based on spatial random effects
estimates, maps of the average predicted risk of strabismus diagnosis
were created. ZCTAs with increased and decreased risk according to
95% credible intervals were identified.
.
Results: Of approximately 500,000 eligible children in Michigan,
roughly 7500 (~ 1.5%) received ≥ 1 strabismus diagnosis in
the analysis time period, with an interquartile range (IQR) of
approximately 0.9% to 2.1%. Communities with lower strabismus
diagnosis rates included Flint, Saginaw, and portions of Lansing and
Detroit. Areas of increased strabismus rates included Traverse City
and portions of Grand Rapids and Detroit. Of over 90,000 eligible
children in the Raleigh-Durham-Cary CSA, approximately 800 (~
0.9%) received a strabismus diagnosis in the study period, with
an IQR of roughly 0.4% to 1.2%). Areas of decreased strabismus
diagnosis rate included Siler City and parts of eastern Raleigh. Areas
of increased strabismus rates included Durham and Chapel Hill.
Conclusions: Analysis of geographic patterns of care associated
diagnoses can reveal differences across geographic regions at
both state and local units of analysis. The information can inform
decisions about resource allocation for expanding access to eye care
services by targeting interventions at areas with lower than expected
rates of diagnosis.
Commercial Relationships: Paul P. Lee, None; Joshua D.
Stein, None; Rebecca Anthopolos, None; Joshua Tootoo, None;
Christopher A. Andrews, None; Marie Lynn Miranda, None
Support: Kellogg Foundation
Program Number: 1395 Poster Board Number: A0090
Presentation Time: 8:30 AM–10:15 AM
Assessment of Intraocular Pressure Surveillance in Children with
Otherwise Normal Eye Exam
Janice Lee, Sylvia Kodsi, Steven E. Rubin, Majida Gaffar.
Ophthalmology, North Shore LIJ Health System, Great Neck, NY.
Purpose: A review of literature revealed no standardized guidelines
for routine measurement of intraocular pressure (IOP) in children
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
with a normal exam. We surveyed pediatric ophthalmologists
nationwide to assess current practice patterns.
Methods: With IRB approval, a survey was sent to members of the
American Association for Pediatric Ophthalmology and Strabismus
in order to assess: surveillance of IOP, method of surveillance, age
at initiation, modifying factors, frequency of elevated IOP, years
in practice, practice location and type. Statistical significance was
assessed by Fisher’s exact test.
Results: 181 (56%) routinely check IOP out of 323 respondents.
The most common age groups when screening is initiated are 10-12
(38.7%) and 13-15 (28.3%). The preferred methods of monitoring
were Goldmann applanation (38.3%), Tonopen (27.2%), and Icare
(29.4%). 101 (55.8%) rely on patient cooperation “very heavily,”
while 66 (36.5%) relied only “moderately.” 61 (33.9%) found
elevated IOP once a year, 33 (18.3%) once every other month, while
29 (16.1%) reported “never” finding elevated IOP in their practice.
123 (68.3%) work with an orthoptist or optometrist who checks the
child’s IOP. Out of all respondents, there was no correlation between
a practitioner checking IOP routinely and: years in practice, region of
practice and type of practice (p=0.93, p=0.13, p=0.82, respectively).
Among physicians who do routinely check IOP, significant
associations were found between years in practice and method of
checking IOP (p=0.026), and between region of practice and method
of checking IOP (p=0.0097). Those with greater numbers of years in
practice (>16) and who practice in the Northeastern, Mountain and
Western regions used Goldmann more than other methods. Those
with fewer years of practice (<10) used Rebound and Icare more
than the Goldmann method, while practitioners in the Southeast used
Tonopen, Rebound and Icare more than other methods.
Conclusions: There is no consensus among pediatric
ophthalmologists for routinely assessing IOP in normal children
despite the fact that increased IOP is found infrequently in this
population. This data demonstrates the importance of developing
guidelines for a standard of care in monitoring intraocular pressure in
children with otherwise normal eye exams.
Commercial Relationships: Janice Lee, None; Sylvia Kodsi, None;
Steven E. Rubin, None; Majida Gaffar, None
Program Number: 1396 Poster Board Number: A0091
Presentation Time: 8:30 AM–10:15 AM
Identifying Strategies for Improving Patient Comfort during
Intravitreal Injections
Jessica Gomez1, Alex Feng2, Mitchell Holt2, Melissa Mackley2, Joseph
M. Terry1, Dara Koozekanani1, Richard H. Johnston1, Erik J. Van
Kuijk1, Robert Beardsley1, Sandra R. Montezuma1. 1Ophthalmology,
University of Minnesota, Minneapolis, MN; 2University of
Minnesota, Minneapolis, MN.
Purpose: Intravitreal injections are the most widely used method
of pharmacological drug delivery for the treatment of many ocular
diseases including age-related macular degeneration. This study aims
to identify potential strategies for improving patients’ experience with
these injections. Our goal is to identify factors that may help alleviate
stress, discomfort or anxiety patients may experience during the
process. Through improving the patients’ experience with intravitreal
injections, we hope to increased patient treatment compliance and
quality of life.
Methods: 128 patients at two separate retina clinics who were
receiving or who had previously received an intravitreal injection
for treatment of their ocular conditions were given a survey with
10- yes/no questions. Questions prompted patients to indicate their
preferences for/or against potential strategies for improving comfort
surrounding intravitreal injections. Patient survey responses were
stratified by gender, condition and total number of injections ever
received.
Results: From the 128 patients surveyed, the following results were
indentified as items that could potentially improve general comfort
while receiving an intravitreal injection. 51% (n=66) preferred having
a technician/staff present (in addition to the physician) during the
injection, ~55% (n=70) would prefer a pillow placed under their neck
during the injection, 58% (n=75) would like a verbal warning prior
to injection and 69% (n=89) preferred having both eyes injected on
the same day if needed. Less favorable strategies (defined as those
that <50% patients indicated as helpful) included: background music,
dim lighting, holding hand, squeezing a stress ball or having a family
member/significant other present. When stratified by gender, >50%
of both male and female patients preferred having a pillow placed
underneath their neck, a verbal warning and having both eyes injected
on the same day if needed. Additionally, >50% of females wanted an
extra staff/technician present as well as someone to hold their hand
during the injection.
Conclusions: More than half of patients surveyed agreed on the
following as effective strategies for improving their comfort during
an intravitreal injection: having an extra technician/staff member
present during the injection, having a pillow placed under their neck,
having a verbal warning prior to injection and having both eyes
injected on the same day if needed.
Commercial Relationships: Jessica Gomez, None; Alex Feng,
None; Mitchell Holt, None; Melissa Mackley, None; Joseph M.
Terry, None; Dara Koozekanani, None; Richard H. Johnston,
None; Erik J. Van Kuijk, None; Robert Beardsley, None; Sandra
R. Montezuma, Research to Prevent Blindness (F), The Minnesota
Lions Vision Foundation (F)
Program Number: 1397 Poster Board Number: A0092
Presentation Time: 8:30 AM–10:15 AM
Alterations to Clinic Workflow for Patients Undergoing
Intravitreal Therapy: A Time-Study Evaluation and Patient
Satisfaction Survey
Jamie Reese, Justis P. Ehlers. Cole Eye Institute, Cleveland Clinic,
Cleveland, OH.
Purpose: Patients receiving intravitreal therapy are often burdened
with frequent and long clinic visits. In order to facilitate reduced
wait-times and improved patient satisfaction, changes were
implemented to clinic scheduling and overall workflow. The purpose
of this study is to assess the impact of those changes on patient visit
times and patient satisfaction.
Methods: This was a retrospective review of clinic workflow and
a patient satisfaction survey. IRB exemption was granted from the
Cleveland Clinic. Previous clinic workflow standard (Phase A) was
as follows: check-in, technician work-up, imaging, physician exam,
preparation and injection of intravitreal therapy, if needed. Each step
required a room change and a wait period.
To streamline the process, we created a “fast-track” workflow
(Phase B). We analyzed the “unnecessary” steps and excess in the
process. A new visit type was created to identify those patients who
were undergoing intravitreal therapy (e.g. PRN, treat-and-extend,
regular interval). A special folder is utilized to identify those patients
throughout the visit. After imaging, the patient is placed directly
into a designated fast-track room, where the patient remains for the
duration of the visit.
To assess the effectiveness of these changes, we identified 25
patients who had 2 visits in both Phase A and Phase B. Time points
for various milestones of the visits were collected from the medical
record (e.g., check-in, dilation, check-out) and compared between
the 2 phases. A patient survey was also administered regarding their
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
experience in both Phase A and Phase B, such as perceived number of
stops and wait times (1 being best, 4 being worst).
Results: Mean time from work-up to check-out time was 86 min in
Phase A. This was reduced to a mean time of 71 min in Phase B, a
17% reduction (p = .003). The mean patient satisfaction score for
wait time during Phase A was 2.6/4, following the change the mean
score during Phase B was 1.4/4.
Conclusions: Our results suggest that simple changes to clinic
workflow and overall assessment of “wasted” time can improve visit
times and patient experience in the vitreoretinal clinic for patients
undergoing intravitreal therapy.
Commercial Relationships: Jamie Reese, None; Justis P. Ehlers,
Alcon (C), Bioptigen (C), Bioptigen (P), Genentech (F), Leica (C),
Synergetics (P), Thrombogenics (C), Thrombogenics (F), Zeiss (C)
Support: NIH/NEI K23-EY022947-01A1 (JPE)
Program Number: 1398 Poster Board Number: A0093
Presentation Time: 8:30 AM–10:15 AM
Clinical characteristics and benefit of cataract intervention
amongst UK domiciliary eye care recipients
Amy L. Sheppard1, 2, James S. Wolffsohn1, 2, Khaled Rashid1. 1School
of Life and Health Sciences, Aston University, Birmingham, United
Kingdom; 2Aston Research Centre for Healthy Ageing, Birmingham,
United Kingdom.
Purpose: Given the ageing UK population and the high prevalence
of activity-limiting illness and disability in the over 65s, the demand
for domiciliary eye care services is set to grow significantly. Over
400,000 NHS domiciliary eye examinations are conducted each
year, yet minimal research attention has been directed to this mode
of practice or patient needs amongst this group. The study aimed
to compare clinical characteristics and benefits of cataract surgery
between conventional in-practice patients and domiciliary service
users.
Methods: Clinical characteristics were compared between patients
in North-West England receiving NHS domiciliary eye care
services (n = 197; median age 76.5 years), and an age-matched
group of conventional in-practice patients (n = 107; median age
74.6 years). Data including reason for visit; logMAR uncorrected
and best corrected distance (UDVA and CDVA) and near acuities
(UNVA and CNVA); presence of ocular pathology and examination
outcome were documented retrospectively. To compare the benefit of
cataract surgery in terms of functional capacity between the patient
groups, individuals undergoing routine referral for first-eye surgery
completed the VF-14 questionnaire pre-operatively, and at 6 weeks
post-operatively.
Results: UDVA was similar between the two groups (median 0.48
and 0.50 logMAR in the domiciliary and practice groups, P = 0.916);
CDVA was significantly worse in the domiciliary group (median 0.18
vs 0.08 logMAR, P<0.001), who were more likely to have clinicallysignificant cataract. Both groups showed similar improvements in
VF-14 scores following cataract surgery (mean gains 24.4 ± 11.7,
and 31.5 ± 14.7 points in the in-practice and domiciliary groups,
respectively. P = 0.312).
Conclusions: Patients receiving domiciliary eye care services are
more likely to have poorer corrected vision than in-practice patients
of a similar age, partly due to a higher prevalence of significant
cataract. Despite limitations in their activities due to illness and
disability, domiciliary patients experience similar gains in selfreported functional capacity following cataract surgery.
Commercial Relationships: Amy L. Sheppard, None; James S.
Wolffsohn, None; Khaled Rashid, None
Support: Central (LOC) Fund UK
Program Number: 1399 Poster Board Number: A0094
Presentation Time: 8:30 AM–10:15 AM
Big data visualizations of disparities in US cataract surgery
delivery
Aaron Y. Lee1, Cecilia S. Lee2. 1Ophthalmology, University of British
Columbia, Vancouver, BC, Canada; 2Department of Ophthalmology,
University of Washington, Seattle, WA.
Purpose: To analyze the pattern in cataract care delivery at the
national level by combining the US Census and Centers for Medicare
& Medicaid Services (CMS) Medicare Provider Utilization and
Payment data.
Methods: Cross-sectional study based on two publicly available
sources: CMS Medicare Provider Data (https://data.cms.gov) and
2010 data from the United States Census Bureau. All analyses were
performed with Python, PostGIS, and R. Reverse geocoding was
performed on all addresses from the Medicare dataset. A hexagon
layer was created to normalize the US Census data. The expected
number of cataract extractions (CE) in one year by decade of life
were extrapolated using a Gaussian Process model (Erie et al., 2007).
A general linear regression model was used to compare differences
among US regions.
Results: There were 2.2 million Medicare patients who underwent
CE in 2012. The expected number of CE and distance to nearest
cataract surgeon are shown in Figure 1A,B. There were 1901
expected cataracts more than 100 miles from the nearest cataract
surgeon, and a rank order of these states were calculated (Figure 2A).
A 50 mile average was calculated for expected number of CE versus
observed number of CE, split by US economic regions (Figure 2B). A
ratio between these two values was significantly different among US
regions (p < 2.2e-16) and was used to create a choropleth of cataract
surgery disparity (Figure 1C).
Conclusions: There is a significant discrepancy in cataract delivery
across the country based on geographic and economic regions.
Publicly available Medicare datasets are valuable tools that can
delineate public access and utilization patterns in the US healthcare
system.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Figure 1: A: Choropleth of the continental US shaded by expected
number of cataract extraction (CE). Darker blue areas represent
higher density of CE. B: Lines drawn from each area to the nearest
cataract surgeon shaded by expected number of CE. Each red dot
represents one surgeon. C: Choropleth of the ratio between the 50
mile summed observed CE and the expected number of CE with more
intense blue areas having more surgeries performed than expected
and red areas having fewer surgeries performed than expected.
Figure 2: A: Boxplot of expected number of cataract surgeries that
were greater than 100 miles from the nearest cataract surgeon by
state. B: Scatterplot of 50 mile summed observed and expected
number of cataract surgeries colored by US economic region.
Commercial Relationships: Aaron Y. Lee, None; Cecilia S. Lee,
None
Program Number: 1400 Poster Board Number: A0095
Presentation Time: 8:30 AM–10:15 AM
Rates of Vitrectomy Among Enrollees in a United States
Managed Care Plan, 2001-2012
Thomas J. Wubben, Nidhi Talwar, Taylor Blachley, Thomas Gardner,
Mark W. Johnson, Paul P. Lee, Joshua D. Stein. Ophthalmology and
Visual Sciences, University of Michigan, Ann Arbor, MI.
Purpose: In recent years, there have been advances in
pharmacological treatment options for many retinal diseases,
improvements in imaging technology, and improved surgical
techniques. Further, better care of diabetes and its complications
have reduced overall mortality and the risk of visual impairment.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
The purpose of this study is to assess whether such advances have
impacted rates of vitrectomy surgery over the past decade.
Methods: Claims data from a managed-care network were analyzed
on all patients ≥ 21 years old at plan entry between 2001 and 2012.
Enrollees who underwent ≥1 pars plana vitrectomy (CPT codes
67036, 67108, 67038, 65260, 67039, 65265, 67040, 67299, 66990,
66850) were identified. Rates of vitrectomy per 1000 enrollees
were computed each year from 2001-2012 for the entire group and
separately for patients with diabetes mellitus.
Results: During the 12 year period examined, 39,143 vitrectomies
on 36,616 enrollees were performed. The average age of those
undergoing vitrectomy was 55 ± 15.4 years and the majority were
white (79.1%) and male (56.5%). Overall vitrectomy rates increased
17% from 2001 to 2005, peaking at 1.50 per 1000 patients. From
2005 to 2010 vitrectomy rates decreased by 39% such that the rate
was 0.91 per 1000 patients in 2010. The rate of vitrectomy among
persons with diabetes substantially decreased by 61% from 2002
(5.19 per 1000 patients) to 2012 (2.01 per 1000 patients). The most
common indications for vitrectomy were retinal detachment, macular
hole/pucker, disorders of the vitreous, and diabetic retinopathy.
Conclusions: There was a substantial decline in utilization of pars
plana vitrectomy in this large managed-care network over the course
of the past decade. This trend was observed for the overall sample as
well as for the subset of enrollees with diabetes. These changes may
be explained in part by advances in diabetes care.
Commercial Relationships: Thomas J. Wubben, None; Nidhi
Talwar, None; Taylor Blachley, None; Thomas Gardner, Johnson
& Johnson (C), Kalvista (C), NovoNordisk (C); Mark W. Johnson,
None; Paul P. Lee, CDC (C); Joshua D. Stein, None
Support: Research to Prevent Blindness “Physician Scientist Award”
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].