In presentations at its annual meeting in October, the AAO revealed that close to one-third of the nation’s eye physicians and surgeons are participating in the IRIS Registry, which is the first comprehensive database of eye diseases and conditions in the United States.
The IRIS (Intelligent Research In Sight) Registry is a centralized data repository and reporting tool that aggregates patient data from electronic health records to perform statistical analysis. It provides information that enables ophthalmologists to improve patient care, potentially reduce cost and enhance the speed of some large clinical trials, assist in monitoring resource utilization and comply with federal incentive programs. In less than a year after announcing a limited roll out during the AAO’s 2013 annual meeting, the IRIS Registry is being utilized by more than 5,000 ophthalmologists across the country, with data related to more than 10 million patient visits.
“The IRIS Registry is proving to be a revolutionary tool that Academy member physicians are embracing as a catalyst for improving the quality of care we can provide to our patients,” said David W. Parke II, MD, CEO of the AAO. “Ophthalmologists are now able to harness the power of many millions of pieces of clinical information in order to make evidence-based patient care analyses that were not previously possible.”
The ophthalmology database provides the ability for clinical benchmarking at the practice, regional and national levels, enabling physicians to monitor patient care, track interventions and evaluate outcomes across different populations. It features subspecialty modules that can help analyze how different pre-existing conditions, risk factors, severity of disease and demographics affect outcomes for age-related macular degeneration, cataract surgery, diabetic retinopathy and retinal surgery.
Though the IRIS Registry is still in its infancy, it is already generating aggregate data that hint at the insights that will be available as more information enters the system. The following has been revealed about patients seen by ophthalmologists participating in the IRIS Registry thus far:
• 2 percent of patients without comorbidities require an additional procedure for complications within 30 days after cataract surgery (not including YAG laser);
• 80 percent of patients without comorbidities have a vision of 20/30 or better within 90 days after cataract surgery;
• 10 percent of patients have age-related macular degeneration;
• 46 percent of patients with age-related macular degeneration receive counseling about antioxidants when seen by an ophthalmologist;
• 11 percent of all patients have primary open-angle glaucoma; and
• 6 percent of all patients in the IRIS Registry have diabetic retinopathy.
“Within a very short amount of time, ophthalmology practices are already making meaningful improvements in patient care, based on information gleaned from IRIS Registry data,” said William L. Rich III, MD, medical director of health policy for the AAO. “As the database continues to grow, our profession will have a wealth of statistically relevant data that will fill many gaps in ophthalmic knowledge to improve the overall quality of patient care.”
The IRIS Registry is available exclusively to all U.S.-based Academy members and their practices at no cost.
Study Ties MS and Uveitis Diagnoses
The results of the
largest retrospective study of multiple sclerosis in uveitis patients has revealed that nearly 60 percent of patients with both diseases were diagnosed with each within a five-year span. While it has long been known that there is an association between the eye condition and MS, this is the first study to provide a detailed description of the relative onset of uveitis and MS and to calculate the likelihood of an MS diagnosis among uveitis patients.
Diagnosed in approximately 38,000 Americans a year, uveitis causes swelling and irritation of the middle layer of the eye and can lead to permanent vision loss if left untreated. It is well-established in the medical community that uveitis can be a sign of MS and it is estimated that 1 to 10 percent of MS patients have uveitis. The disease affects approximately 2.3 million people worldwide, causes irreversible nerve deterioration and is notoriously difficult to diagnose.
To achieve a better understanding of the association of the two diseases, researchers from Casey Eye Institute at the Oregon Health & Science University and the University of Heidelberg, Germany conducted a database search of approximately 3,000 patients with uveitis from the Casey Eye Institute and 5,319 patients from the University of Heidelberg between 1985 and 2013. Of these, 24 patients from the Casey Eye Institute and 89 patients from the University of Heidelberg fulfilled the inclusion criteria of diagnoses for both uveitis and MS and were included in the study.
Based on the prevalence of MS in American and European populations, the researchers found that MS is 18 times and 21 times more likely in an American and European population with uveitis, respectively, relative to the general population. The study found that MS was diagnosed before uveitis in 28 (29 percent) of patients, simultaneously in 15 (15 percent) of patients and after uveitis diagnosis in 54 (56 percent) of patients.
“With a population size four-times larger than any study to date on this topic, our study provides a wealth of clinical information to allow clinicians to make more accurate diagnoses while giving patients a better understanding of their prognosis,” said Wyatt Messenger, MD, lead researcher from the Casey Eye Institute (now a research fellow at the University of Utah). “Knowing more about the onset may enable patients to seek treatment earlier, therefore slowing the progression of the disease and limiting the damage done to the nervous system.”
Additionally, this is the first study to estimate the relative frequency of anatomical sub-types of uveitis in patients with MS. Traditionally, uveitis in patients with MS is said to present with intermediate uveitis (also referred to as pars planitis). While 80 percent of cases in this study had intermediate uveitis at the time of MS diagnosis, researchers found that nearly one in six of participants presented with anterior uveitis. The study also showed that visual acuity is generally stable in this population; the majority of patients improved during follow-up after treatment.
The researchers noted that a major limitation of the study is the lack of availability of brain magnetic resonance images on all of the patients or detailed neurological studies, which would have allowed correlation of the patients’ uveitis with their neurological disease.
Smartphone Aids Diabetes Diagnosis
A smartphone-based tool may be an effective alternative to traditional ophthalmic imaging equipment in evaluating and grading severity of a diabetic eye disease, according to a study released at the American Academy of Ophthalmology meeting in Chicago last month. The results of the research indicate the lower-cost method could be useful for bringing the service to patients in isolated or underserved communities.
Researchers from the University of Brescia, University of Molise and “Federico II” University of Naples, Italy, developed a small optical adapter called D-Eye, which could attach magnetically to an iPhone 5, creating a smartphone ophthalmoscope. They then used the iPhone ophthalmoscope as well as a slit-lamp biomicroscope to perform dilated retinal digital imaging on 120 patients with diabetes who were scheduled to have a routine dilated eye exam. After comparing the results of the smartphone method to the traditional one, an exact agreement between the two methods was found in 85 percent of the eyes and an agreement within one step (or grade of disease progression) was found in 96.7 percent of the eyes. In most of the one- and two-step disagreements, the severity level was graded higher by biomicroscopy grading.
In the smartphone ophthalmoscopy results, nine eyes were not gradable due to small pupil or cataract. In the biomicroscopy results, the number of non-gradable images was four. Therefore, while biomicroscopy is still found to be the more accurate method for grading diabetic retinopathy, researchers believe smartphone ophthalmoscopy shows great potential for use in rural or remote communities who would normally receive little to no testing at all.
“Using the iPhone method is thousands of dollars cheaper than using traditional equipment,” said lead researcher Andrea Russo, MD. “The affordability of this option could make it much easier to bring eye care to non-hospital remote or rural settings, which often lack ophthalmic medical personnel.”
Stem Cells Derived From Limbus
Scientists at the University of Southampton in England have discovered that the corneal limbus harbors special stem cells that could treat blinding eye conditions. The research, published in
PLOS ONE, showed that stem cells can be cultured from the corneal limbus in vitro. Under the correct culture conditions, these cells could be directed to behave like photoreceptor cells.
The loss of photoreceptors cells causes irreversible blindness, and researchers hope this discovery could lead to new treatments for conditions such as age-related macular degeneration. Professor Andrew Lotery, of the University of Southampton and a consultant ophthalmologist at Southampton General Hospital, led the study. He comments: “These cells are readily accessible, and they have surprising plasticity, which makes them an attractive cell resource for future therapies. This would help avoid complications with rejection or contamination because the cells taken from the eye would be returned to the same patient. More research is now needed to develop this approach before these cells are used in patients.” Furthermore, these stem cells also exist in aged human eyes, and can be cultured even from the corneal limbus of 97-year-olds. Therefore this discovery opens up the possibility of new treatments for the older generations, researchers believe.