Etiology, Treatment Patterns, and Outcomes for Choroidal Neovascularization in the Pediatric Population: An Intelligent Research in Sight (IRIS®) Registry Study.

OBJECTIVE: Choroidal neovascularization (CNV) is a rare, but devastating, cause of vision loss in children, with most current publications limited to small case series. Using a large clinical registry allowed us to understand the most common causes of this disease and the visual outcomes. DESIGN: Retrospective analysis. PARTICIPANTS: Patients younger than 18 years in the Intelligent Research in Sight Registry diagnosed with CNV between 2013 and 2019. METHODS: Cases were identified based on International Classification of Diseases, Ninth and Tenth Revisions, diagnosis codes for CNV or CNV-related etiology and Current Procedural Terminology treatment codes. MAIN OUTCOME MEASURES: Etiology of CNV, treatment patterns, and visual outcomes. RESULTS: Two thousand three hundred fifty-three eyes with pediatric CNV were identified. The most common identifiable causes of pediatric CNV were posterior uveitis or inflammatory chorioretinal disease (19.4%), myopia (18.4%), hereditary dystrophy (5.4%), chorioretinal scar (4.2%), choroidal rupture (3.5%), optic nerve drusen (3.2%), osteoma (1.9%), and solar retinopathy (0.2%). In 38.2% of eyes, CNV was idiopathic, and in 5.7% of eyes, multiple causes were coded. One thousand forty-one eyes (44.4%) underwent treatment. The mean age of mean age of patients whose eyes received treatment 13.6 ± 3.5 years compared with 12.4 ± 4.1 years for the untreated group (P < 0.001). In 88.9% of eyes, anti-vascular endothelial growth factor (VEGF) injections were administered, 7.9% of eyes received laser therapy, 0.3% of eyes received photodynamic therapy, and 2.9% of eyes received combination therapy. In the eyes receiving anti-VEGF agents, 68.4% required 3 injections or fewer (P < 0.0001). Eyes undergoing treatment exhibited worse baseline visual acuity (VA) than eyes that did not undergo treatment (0.62 ± 0.50 logarithm of the minimum angle of resolution [logMAR] vs. 0.44 ± 0.50 logMAR; P < 0.0001). Visual acuity in the treatment group improved significantly from 0.62 ± 0.50 logMAR at baseline to 0.39 ± 0.43 logMAR at year 1 (P < 0.0001). Visual acuity in the untreated group improved significantly from 0.44 ± 0.50 logMAR at baseline to 0.34 ± 0.44 logMAR at year 1 (P < 0.001). Treated eyes showed a statistically significant higher odds of exhibiting a 2-line vision improvement or better compared with the untreated group at 12 months regardless of treatment type and after controlling for baseline VA (odds ratio, 2.4; P < 0.0001). CONCLUSIONS: CNV is a rare, sight-threatening condition in children, with the most common causes being idiopathic, inflammatory chorioretinal disease, and myopia. Eyes undergoing treatment tended to be in older patients and showed worse baseline VA compared with eyes that did not undergo treatment. Those that were treated experienced significant improvement in vision that was maintained in the long term.

Factors Associated With Laser Trabeculoplasty Response Duration: Analysis of a Large Clinical Database (IRIS Registry).

PRCIS: In eyes with trabeculoplasty response, those with lower baseline pressure, angle recession or uveitis had shorter survival. Eyes without medications before treatment remained medication-free for a median of 197 days. PURPOSE: We examined patients in a large clinical registry to assess factors associated with laser trabeculoplasty (LTP) response durations. METHODS: This is a retrospective cohort study with LTP patients in the Intelligent Research in Sight Registry. Data were extracted if the eye had a LTP procedure code and a glaucoma diagnosis. In responders [≥20% intraocular pressure (IOP) reduction], any post-LTP IOP that was above 80% of baseline was considered a failure event. Eyes were censored if IOP-lowering medication/procedure was added/performed, or if the eye reached the end of follow-up. First eye of bilaterally treated patients were included. RESULTS: A total of 79,332 patients/eyes were included; 53.2% female; mean age 71.5 years; 64.5%White; 71.2% primary open angle glaucoma. Mean baseline IOP was 21.6±5.3 mm Hg (2.1±1.5 medications). Eyes with higher baseline IOP had longer survival (>24 mm Hg median 349 d; 18 to 24 mm Hg median 309 d; <18 mm Hg median 256 d, P<0.001 for all comparisons). Overall failure at 0, 6, 12, 18 and 24 months were 0.2%, 6.1%, 16.8%, 29.1%, and 40.8%. Angle recession and uveitis increased the risk of failure (hazard ratios 1.69 and 1.80, respectively). Eyes without medications at baseline remained medication-free for a median of 197 days (interquartile range 106, 395 d). CONCLUSIONS: Angle recession and uveitis increase the risk of LTP failure. LPT may be effective in prolonging medication-free IOP-control in some patients.

Clinical Outcomes of Rhegmatogenous Retinal Detachment Treated With Pneumatic Retinopexy.

IMPORTANCE: Pneumatic retinopexy (PR) is the only clinic-based method of rhegmatogenous retinal detachment (RRD) repair. Registry-acquired clinical practice setting outcomes data with this procedure have not yet been reported. OBJECTIVE: To describe the clinical outcomes associated with RRD treated primarily with PR. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, data from patients 19 years and older with noncomplex RRD treated at academic and private ophthalmology practices participating in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) were analyzed. Data were collected from January 1, 2013, to December 31, 2019, and data were analyzed from January to December 2020. EXPOSURES: Data from the IRIS Registry were queried for eyes that underwent PR for noncomplex RRD and had at least 3 months of follow-up. Cases were identified by a combination of diagnosis code for RRD and a Current Procedural Terminology code for PR. MAIN OUTCOMES AND MEASURES: The number of eyes that achieved single-operation success (SOS), defined as retinal reattachment without a subsequent retinal detachment surgery or repeated PR. RESULTS: Of 9553 included patients, 5827 (61.0%) were male, and the mean (SD) age was 62 (10) years. A total of 9659 eyes were identified. SOS was achieved in 6613 eyes (68.5%). Best-corrected visual acuity significantly differed 9 to 12 months after treatment between the SOS group, with a mean of 0.24 logMAR (95% CI, 0.23-0.25; approximate Snellen equivalent, 20/35), and the single-operation failure group, with a mean of 0.43 logMAR (95% CI, 0.40-0.46; approximate Snellen equivalent, 20/54). Among all patients, the mean time to maximal visual recovery was 268 days (95% CI, 260-276). Endophthalmitis was observed in 3 eyes (0.03%). SOS was associated with female sex (odds ratio, 1.51; 95% CI, 1.38-1.65), while current smoking status was associated single-operation failure (odds ratio, 0.78; 95% CI, 0.68-0.91). CONCLUSIONS AND RELEVANCE: In this registry-based study, which encompasses a large number of eyes drawn from multiple, heterogenous electronic health record systems, SOS was achieved in 68.5% of eyes with noncomplex RRD treated by primary PR. It is unknown how these outcomes would have compared with other methods of RRD repair in this cohort.

Demographic and Clinical Characteristics Associated with Minimally Invasive Glaucoma Surgery Use: An Intelligent Research in Sight (IRIS®) Registry Retrospective Cohort Analysis.

PURPOSE: Minimally invasive glaucoma surgery (MIGS) is increasingly performed at the time of cataract extraction. Understanding the demographic and clinical characteristics of patients undergoing MIGS procedures may provide insight into patient selection. This study evaluates racial-ethnic and other differences in the use of MIGS in persons with cataract and open-angle glaucoma (OAG). DESIGN: Retrospective cohort study using Intelligent Research in Sight (IRIS) Registry data. PARTICIPANTS: Patients aged ≥ 40 years with a diagnosis of OAG and no history of MIGS or cataract surgery who were undergoing cataract extraction, with or without MIGS, during 2013 to 2017 in the United States. METHODS: Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURES: Variables assessed include age, sex, race-ethnicity, disease severity, insurance type, census region, comorbidity, and cup-to-disc ratio (CDR). RESULTS: The odds of MIGS use was greater among patients who were aged ≥ 60 years (OR, 1.10 [95% CI, 1.05-1.16]); Black (OR, 1.11 [CI, 1.07-1.15]) compared with White; a Medicare recipient (OR, 1.12 [CI, 1.10-1.15]) versus privately insured; or in the Midwest (OR, 1.32 [CI, 1.28-1.36]) or Northeast (OR, 1.26 [CI, 1.22-1.30]) compared with the South. Having moderate rather than mild glaucoma (OR, 1.07 [CI, 1.04-1.11]) and a higher CDR (OR for 0.5 to 0.8 vs. <0.5, 1.24 [CI, 1.21-1.26]; OR for >0.8 to 1.0 vs. <0.5, 1.27 [CI, 1.23-1.32]) were also each associated with increased odds of MIGS use. Use of MIGS was less likely in women (OR, 0.96 [CI, 0.94-0.98]); patients taking 5 to 7 glaucoma medications (OR, 0.94 [CI, 0.90-0.99]) compared with 1 to 2 medications; and patients with severe, compared with mild, glaucoma (OR, 0.64 [CI, 0.61-0.67]). CONCLUSIONS: This analysis highlights the importance of capturing race-ethnicity data and other pertinent patient characteristics in electronic health records to provide insight into practice patterns. Such data can be used to assess the long-term performance of MIGS and other procedures in various patient populations.

Factors Associated With Favorable Laser Trabeculoplasty Response: IRIS Registry Analysis.

PURPOSE: We examined patients in a large clinical registry to assess factors associated with laser trabeculoplasty (LTP) responses. DESIGN: Retrospective cohort study. METHODS: StudyPopulation: LTP patients in the Intelligent Research in Sight (IRIS) Registry, 2013-2018. OBSERVATION: IRIS Registry data were extracted if the eye had a procedural code for LTP and a glaucoma diagnosis. Eyes were excluded if LTP laterality or baseline intraocular pressure (IOP) could not be determined. Following LTP, "nonresponders" were those with <20% IOP reduction after 8 weeks, while "responders" were those with ≥20% IOP reduction. MainOutcomeMeasures: Proportion of responders, odds ratios (OR) of pre-LTP factors associated with being a nonresponder. RESULTS: A total of 263,480 eyes were included, with mean age 71.4 ± 11.7 years. Mean baseline IOP was 19.1 ± 5.0 mm Hg, mean number of pre-LTP medications was 2.1 ± 1.5. Response rate was 36.9% overall and 68.8% for those with baseline IOP >24 mm Hg. Higher baseline IOP was associated with reduced odds of nonresponse (OR = 0.60, P < .0001 for a 3 mm Hg increase). Angle recession, uveitis, and aphakia increased the odds of a nonresponse (ORs 2.46, 1.50 (both P < .0001), and 1.55 (P = .0259), respectively). In nonresponders with at least 1 medication at baseline, 76.3% of eyes had fewer medications postoperatively. CONCLUSIONS: Lower baseline IOP, angle recession, uveitis, and aphakia were associated with increased odds of nonresponse. Future studies that analyze LTP responder survival and implementation lag would facilitate resource optimization in glaucoma therapy.