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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].