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Wong WM, Tham YC, Ayton LN, Britten-Jones AC, Edwards TL, Grigg J, Simunovic MP, Chen FK, Jin ZB, Shen RJ, Sui R, Yang L, Zhao C, Chen H, Li S, Ding X, Bhende M, Raman R, Sen P, Poornachandra B, Valen C, Manurung F, Sasongko MB, Ikeda H, Fujinami K, Woo SJ, Kim SJ, Bastion MLC, Kamalden AT, Lott PP, Fong K, Shunmugam M, Lim A, Thapa R, Ibañez BMB, Koh A, Holder GE, Su X, Chan CM, Fenner BJ, Laude A, Ngo WK, Chen TC, Wang NK, Kang EYC, Surawatsatien N, Pisuchpen P, Sujirakul T, Wongchaisuwat N, Apivatthakakul A, Kumaramanickavel G, Leroy B, Michaelides M, Pontikos N, Cheng CY, Pang CP, Chen LJ. Practice Patterns and Challenges in Managing Inherited Retinal Diseases across Asia-Pacific: A Survey from the APIED Network. Asia Pac J Ophthalmol (Phila) 2024:100098. [PMID: 39366638 DOI: 10.1016/j.apjo.2024.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/26/2024] [Accepted: 08/26/2024] [Indexed: 10/06/2024] Open
Abstract
PURPOSE The objective of this paper is to shed light on the current landscape of genotyping practices, phenotyping practices and availability of essential vision rehabilitation management for inherited retinal diseases (IRD) in the Asia-Pacific (APAC) Region. METHODS The 62-item questionnaire was distributed electronically via email. The questions covered five domains: (1) structure of the IRD service and registry/database; (2) genotyping practices; (3) genetic counselling; (4) deep phenotyping practices; (5) low-vision rehabilitation services. RESULTS The survey was completed by 36 of 45 centres in twelve countries and regions in APAC. Among these centres, 42% reported managing more than 1000 patients. Notably, 39% of centres lack an IRD database or registry, and 44% of centres have tested less than one-quarter of their IRD patients. The majority of centres (67%) do not have genetic counsellors. While there was consistency in the imaging-based investigations, there was marked heterogeneity for functional testing using electrophysiology and formal perimetry. Only 34% of centres confirmed the availability of access to low-vision assistive devices. CONCLUSIONS This study reveals several critical gaps in managing IRDs in the APAC region. These include the lack of IRD database/registry in one-third of centres, a substantial proportion of patients remaining genetically undiagnosed, and limited availability of genetic counsellors. The findings also underscore a need to harmonise investigations for evaluating retinal function and identify areas for improvement in the provision of low-vision rehabilitation services.
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Affiliation(s)
- Wendy M Wong
- Centre for Innovation & Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, National University Hospital, National University Health System, Singapore
| | - Yih Chung Tham
- Centre for Innovation & Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lauren N Ayton
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Department of Optometry and Vision Sciences and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Ceecee Britten-Jones
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Department of Optometry and Vision Sciences and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas L Edwards
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Department of Optometry and Vision Sciences and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
| | - John Grigg
- Save Sight Institute, The University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia
| | - Matthew P Simunovic
- Save Sight Institute, The University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Ophthalmology and Visual Science (Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Ren-Juan Shen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Ruifang Sui
- Department of Ophthalmology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 1, Shuai Fu Yuan, Beijing
| | - Liping Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chen Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, Shantou, China
| | - Shiying Li
- Department of Ophthalmology, the First Affiliated Hospital of Xiamen University, School of Medicine, Eye Institute of Xiamen University, Xiamen, Fujian, China
| | - Xiaoyan Ding
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Parveen Sen
- Shri Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Nethralaya, Chennai, India; Dr Agarwal Eye Hospital, Chandigarh, India
| | - B Poornachandra
- Vitreo-Retina Services, Narayana Nethralaya, Bangalore, India
| | - Chia Valen
- JEC Eye Hospitals and Clinics, Jakarta, Indonesia
| | - Florence Manurung
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Muhammad Bayu Sasongko
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Hanako Ikeda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Kaoru Fujinami
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, NHO Tokyo Medical Center, Tokyo, Japan
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mae-Lynn Catherine Bastion
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Ain Tengku Kamalden
- UM Eye Research Centre, Department of Ophthalmology, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Amelia Lim
- Ophthalmology, Penang Gleneagles, Malaysia
| | - Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - B Manuel Benjamin Ibañez
- Makati Medical Center, Makati City, Philippines; DOH Eye Center, East Avenue Medical Center, Quezon City, Philippines
| | - Adrian Koh
- Eye & Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Graham E Holder
- Centre for Innovation & Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, National University Hospital, National University Health System, Singapore
| | - Xinyi Su
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore
| | - Choi Mun Chan
- Ophthalmology & Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Beau J Fenner
- Ophthalmology & Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Augustinus Laude
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wei Kiong Ngo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Center of Frontier Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Nuntachai Surawatsatien
- Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Phattrawan Pisuchpen
- Department of Ophthalmology and Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tharikarn Sujirakul
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nida Wongchaisuwat
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | | | - Bart Leroy
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Nikolas Pontikos
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Ching-Yu Cheng
- Centre for Innovation & Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- The Chinese University of Hong Kong, Hong Kong, China
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2
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O'Day RF, Conway RM, Lim LA, Giblin M, Cherepanoff S, Joshua A, McKay D, McKenzie JD, Fog LS, Holly P, Shackleton M, Kee D, Philips C, McKelvie P, Bhikoo R, Hadden P, Negretti GS, Sagoo MS, Damato BE, Sia D, McGrath L, Glasson W, Isaacs T, Gillies M, Barthelmes D. The Fight Tumour Blindness Registry: Efficient capture of high-quality real-world data in uveal melanoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e525-e533. [PMID: 38810958 DOI: 10.1016/j.jcjo.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/08/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To describe the development of a web-based data collection tool to track the management and outcomes of uveal melanoma patients. DESIGN Description of a clinical registry. PARTICIPANTS Patients with uveal melanoma. METHODS A panel of expert ocular oncologists, with input from other relevant specialties and individuals with expertise in registry development, collaborated to formulate a minimum data set to be collected to track patient centred, real-world outcomes in uveal melanoma. This data set was used to create the Fight Tumour Blindness! (FTB!) registry within Save Sight Registries. RESULTS The data set to be collected includes patient demographics and medical history, baseline visit, follow-up visit including tumour treatment, metastatic staging and surveillance, pathology, and patient-reported questionnaires. The inbuilt mechanisms to ensure efficient and complete data collection are described. CONCLUSIONS The FTB! registry can be used to monitor outcomes for patients with uveal melanoma. It allows benchmarking of outcomes and comparisons between different clinics and countries.
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Affiliation(s)
- Roderick F O'Day
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia. roderick.o'
| | - R Max Conway
- Ocular Oncology Unit, Sydney Eye Hospital and The Kinghorn Cancer Centre, Sydney (New South Wales), Australia; Save Sight Institute, University of Sydney, Sydney (New South Wales), Australia
| | - Li-Anne Lim
- Ocular Oncology Unit, Sydney Eye Hospital and The Kinghorn Cancer Centre, Sydney (New South Wales), Australia; Save Sight Institute, University of Sydney, Sydney (New South Wales), Australia
| | - Michael Giblin
- Ocular Oncology Unit, Sydney Eye Hospital and The Kinghorn Cancer Centre, Sydney (New South Wales), Australia
| | - Svetlana Cherepanoff
- SydPath, Department of Anatomical Pathology, St Vincent's Hospital, Darlinghurst (New South Wales), Australia
| | - Anthony Joshua
- Kinghorn Cancer Centre, St Vincent's Hospital Sydney, Darlinghurst (New South Wales), Australia; Garvan Institute of Medical Research, Darlinghurst (New South Wales), Australia
| | - Daniel McKay
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - John D McKenzie
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Lotte S Fog
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Alfred Health, Melbourne (Victoria), Australia
| | - Peta Holly
- Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Mark Shackleton
- Alfred Health, Melbourne (Victoria), Australia; Central Clinical School, Monash University, Melbourne (Victoria), Australia
| | - Damien Kee
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne (Victoria), Australia; Department of Medical Oncology, Austin Health, Heidelberg (Victoria), Australia
| | - Claire Philips
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne (Victoria), Australia; Department of Medical Oncology, Austin Health, Heidelberg (Victoria), Australia
| | - Penny McKelvie
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Riyaz Bhikoo
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Peter Hadden
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Guy S Negretti
- Department of Ocular Oncology and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Mandeep S Sagoo
- Department of Ocular Oncology and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Bertil E Damato
- Department of Ocular Oncology and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - David Sia
- Departments of Ophthalmology at the Royal Adelaide Hospital and Flinders Medical Centre, Adelaide (South Australia), Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide (South Australia), Australia
| | - Lindsay McGrath
- Queensland Ocular Oncology Service, Brisbane (Queensland), Australia
| | - William Glasson
- Queensland Ocular Oncology Service, Brisbane (Queensland), Australia
| | - Timothy Isaacs
- University of Western Australia, Perth (Western Australia), Australia
| | - Mark Gillies
- Save Sight Institute, University of Sydney, Sydney (New South Wales), Australia
| | - Daniel Barthelmes
- Save Sight Institute, University of Sydney, Sydney (New South Wales), Australia; Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
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Tran L, Kandel H, Sari D, Chiu CH, Watson SL. Artificial Intelligence and Ophthalmic Clinical Registries. Am J Ophthalmol 2024; 268:263-274. [PMID: 39111520 DOI: 10.1016/j.ajo.2024.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE The recent advances in artificial intelligence (AI) represent a promising solution to increasing clinical demand and ever limited health resources. Whilst powerful, AI models require vast amounts of representative training data to output meaningful predictions in the clinical environment. Clinical registries represent a promising source of large volume real-world data which could be used to train more accurate and widely applicable AI models. This review aims to provide an overview of the current applications of AI to ophthalmic clinical registry data. DESIGN AND METHODS A systematic search of EMBASE, Medline, PubMed, Scopus and Web of Science for primary research articles that applied AI to ophthalmic clinical registry data was conducted in July 2024. RESULTS Twenty-three primary research articles applying AI to ophthalmic clinic registries (n = 14) were found. Registries were primarily defined by the condition captured and the most common conditions where AI was applied were glaucoma (n = 3) and neovascular age-related macular degeneration (n = 3). Tabular clinical data was the most common form of input into AI algorithms and outputs were primarily classifiers (n = 8, 40%) and risk quantifier models (n = 7, 35%). The AI algorithms applied were almost exclusively supervised conventional machine learning models (n = 39, 85%) such as decision tree classifiers and logistic regression, with only 7 applications of deep learning or natural language processing algorithms. Significant heterogeneity was found with regards to model validation methodology and measures of performance. CONCLUSIONS Limited applications of deep learning algorithms to clinical registry data have been reported. The lack of standardized validation methodology and heterogeneity of performance outcome reporting suggests that the application of AI to clinical registries is still in its infancy constrained by the poor accessibility of registry data and reflecting the need for a standardization of methodology and greater involvement of domain experts in the future development of clinically deployable AI.
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Affiliation(s)
- Luke Tran
- From the Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, (L.T., H.K., D.S., C.H.C., S.L.W.) Sydney, New South Wales, Australia.
| | - Himal Kandel
- From the Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, (L.T., H.K., D.S., C.H.C., S.L.W.) Sydney, New South Wales, Australia
| | - Daliya Sari
- From the Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, (L.T., H.K., D.S., C.H.C., S.L.W.) Sydney, New South Wales, Australia
| | - Christopher Hy Chiu
- From the Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, (L.T., H.K., D.S., C.H.C., S.L.W.) Sydney, New South Wales, Australia
| | - Stephanie L Watson
- From the Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, (L.T., H.K., D.S., C.H.C., S.L.W.) Sydney, New South Wales, Australia
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Ciociola EC, Sekimitsu S, Smith S, Lorch AC, Miller JW, Elze T, Zebardast N. Racial Disparities in Glaucoma Vision Outcomes and Eye Care Utilization: An IRIS Registry Analysis. Am J Ophthalmol 2024; 264:194-204. [PMID: 38548127 DOI: 10.1016/j.ajo.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE To evaluate racial disparities in vision outcomes and eye care utilization among glaucoma patients. DESIGN Retrospective cohort study. METHODS In this population-based IRIS Registry (Intelligent Research in Sight) study, we included patients with minimum one diagnosis code for glaucoma at least 6 months prior to January 1, 2015 and at least one eye exam, visual field (VF), optical coherence tomography (OCT), or eye-related inpatient or emergency department (ED) code in 2015. Multivariable logistic and negative binomial regression models were used to assess vision and utilization outcomes, respectively, across race and ethnicity from January 1, 2015 to January 1, 2020. Vision outcomes included cup-to-disc ratio (CDR) progression > 0.80, poor vision (visual acuity 20/200 or worse), low vision codes, and need for glaucoma filtering surgery. Utilization outcomes included outpatient eye exams, OCTs, VFs, inpatient/ED encounters, and lasers/surgeries. RESULTS Among 996,297 patients, 73% were non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic, 3% Asian/Pacific Islander, and 0.3% Native American/Alaska Native. Compared to White eyes, Black and Hispanic eyes had higher adjusted odds of CDR progression (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.08-1.17; OR = 1.28, 95% CI = 1.22-1.34), poor vision (OR = 1.26, 95% CI = 1.22-1.29; OR = 1.26, 95% CI = 1.22-1.31), glaucoma filtering surgery (rate ratio (RR) = 1.47, 95% CI = 1.42-1.51; RR = 1.13, 95% CI = 1.09-1.18). Hispanic eyes also had increased odds of low vision diagnoses (Hispanic OR = 1.18, 95% CI = 1.07-1.30). Black and Hispanic patients were less likely to have eye exams (RR = 0.94, 95% CI = 0.94-0.95; RR = 0.99, 95% CI = 0.99-0.99) and OCTs (RR = 0.86, 95% CI = 0.85-0.86; RR = 0.97, 95% CI = 0.96-0.98), yet Black patients had higher odds of inpatient/ED encounters (RR = 1.64, 95% CI = 1.37-1.96) compared to White patients. Native American patients were more likely to have poor vision (OR = 1.17, 95% CI = 1.01-1.36) and less likely to have outpatient visits (RR = 0.89, 95% CI = 0.86-0.91), OCTs (RR = 0.85, 95% CI = 0.82-0.89), visual fields (RR = 0.91, 95% CI = 0.88-0.94) or lasers/surgeries (RR = 0.87, 95% CI = 0.79-0.96) compared to White patients. CONCLUSIONS We found that significant disparities in US eye care exist with Black, Hispanic, and Native American patients having worse vision outcomes and less disease monitoring. Glaucoma may be undertreated in these racial and ethnic minority groups, increasing risk for glaucoma-related vision loss.
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Affiliation(s)
- Elizabeth C Ciociola
- From the Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins (E.C.C.), Baltimore, Maryland, USA
| | - Sayuri Sekimitsu
- Tufts University School of Medicine (S.S., S.S.), Boston, Massachusetts, USA
| | - Sophie Smith
- Tufts University School of Medicine (S.S., S.S.), Boston, Massachusetts, USA
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.)
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.)
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.)
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.).
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Watson SL, Le DTM. Corneal neuropathic pain: a review to inform clinical practice. Eye (Lond) 2024; 38:2350-2358. [PMID: 38627548 PMCID: PMC11306374 DOI: 10.1038/s41433-024-03060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 08/09/2024] Open
Abstract
Corneal neuropathic pain (CNP) is a poorly defined disease entity characterised by an aberrant pain response to normally non-painful stimuli and categorised into having peripheral and central mechanisms, with the former responding to instillation of topical anaesthetic. CNP is a challenging condition to diagnose due to numerous aetiologies, an absence of clinical signs and ancillary tests (in vivo confocal microscopy and esthesiometry), lacking the ability to confirm the diagnosis and having limited availability. Symptomatology maybe mirrored by severe and chronic forms of dry eye disease (DED), often leading to misdiagnosis and inadequate treatment. In practice, patients with suspected CNP can be assessed with questionnaires to elicit symptoms. A thorough ocular assessment is also performed to exclude any co-existent ocular conditions. A medical and mental health history should be sought due to associations with autoimmune disease, chronic pain syndromes, anxiety and depression. Management begins with communicating to the patient the nature of their condition. Ophthalmologists can prescribe topical therapies such as autologous serum eyedrops to optimise the ocular surface and promote neural regeneration. However, a multi-disciplinary treatment approach is often required, including mental health support, particularly when there are central mechanisms. General practitioners, pain specialists, neurologists and psychologists may be needed to assist with oral and behavioural therapies. Less data is available to support the safety and efficacy of adjuvant and surgical therapies and the long-term natural history remains to be determined. Hence clinical trials and registry studies are urgently needed to fill these data gaps with the aim to improve patient care.
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Affiliation(s)
- Stephanie L Watson
- The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia.
- Sydney Eye Hospital, Sydney, NSW, Australia.
| | - Damien Tuan-Man Le
- The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
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Tan JCK, Hashimoto Y, Gabrielle PH, Garcher CC, White A, Dunn H, Walland M, Wechsler D, Arnould L, Lawlor M. Outcomes and Baseline Predictors of Failure in Primary Standalone Xen45 Gel Stent versus Trabeculectomy for Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00132-7. [PMID: 39004222 DOI: 10.1016/j.ogla.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To compare safety, effectiveness, and baseline predictors of failure in standalone primary Xen45 gel stent (Xen) versus trabeculectomy (Trab) in glaucoma. DESIGN Retrospective study. SUBJECTS Subjects that underwent primary Xen or Trab augmented by mitomycin-C with at least 12 months follow-up. METHODS Multinational observational study of eyes in the Fight Glaucoma Blindness international registry MAIN OUTCOME MEASURES: The primary outcome was success at 12 months defined by intraocular pressure (IOP) reduction ≥ 20% from baseline and ≤ threshold IOPs of 15, 18, and 21 mmHg with (qualified) or without (complete) medications and without secondary glaucoma surgery. Multivariable mixed effects Cox regression models were used to identify risk factors for failure in each cohort. RESULTS A total of 701 eyes (Xen, 308; Trab, 393) of 596 subjects were included with baseline IOP being significantly higher (22.4 vs. 19.9 mmHg, P < 0.001) and baseline medications significantly lower in the Xen versus the Trab group (2.9 vs. 3.4, P < 0.001). Baseline visual field mean deviation was less severe in the Xen group (-9.47 vs. -13.04 dB, P < 0.001). The proportion of complete surgical success was significantly lower in the Xen versus Trab group across the 3 upper IOP limits at 12 months; 32% versus 52% at 15 mmHg, 37% versus 54% at 18 mmHg, and 39% versus 55% at 21 mmHg (P < 0.001). The incidence of postoperative numerical and symptomatic hypotony was lower in the Xen versus Trab group. In the Xen cohort, a higher failure rate was associated with Asian ethnicity (hazard ratio [HR], 1.97; 95% confidence interval (CI), 1.03-3.79) and use of oral acetazolamide at baseline (HR, 1.74; 95% CI, 1.13-2.70), whereas a lower failure rate was associated with diagnosis of ocular hypertension/open-angle glaucoma suspect (HR, 0.40; 95% CI, 0.20-0.82) and secondary open-angle glaucoma (HR, 0.46; 95% CI, 0.26-0.82). Exposure to prostaglandin analog was associated with greater failure in the Trab group (HR, 2.66; 95% CI, 1.18-6.01). CONCLUSIONS There was significantly greater complete success at 12 months across all complete success definitions for Trab compared with Xen, whereas the rate of postoperative hypotony was significantly lower in the Xen group. Asian ethnicity and use of oral acetazolamide at baseline were associated with greater failure in Xen, whereas exposure to prostaglandin analog was associated with greater failure in Trab patients. Such baseline predictors of success and failure may help guide patient selection for subconjunctival minimally invasive glaucoma surgery in patients undergoing surgical intervention. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jeremy C K Tan
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
| | - Yohei Hashimoto
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Andrew White
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Hamish Dunn
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Walland
- Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - David Wechsler
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Equipe d'Accueil 7460, Faculty of Health Sciences, Université de Bourgogne Franche-Comté, Dijon, France
| | - Mitchell Lawlor
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
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Leal I, Nogueira V, Matos DB, Araújo J, Berens O, Ribeiro M, Furtado MJ, Liverani M, Silva MI, Guedes M, Cordeiro M, Ribeiro M, José P, Barão R, Nunes Ferreira R, Fonseca S, Mano S, Pina S, Santos MJ, Fonseca JE, Fonseca C, Figueira L. Design and Development of a Web-Based Prospective Nationwide Registry for Ocular Inflammatory Diseases: UVEITE.PT - The Portuguese Ocular Inflammation Registry. Ocul Immunol Inflamm 2024; 32:342-350. [PMID: 36780588 DOI: 10.1080/09273948.2023.2171891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
Uveitis is a heterogeneous collection of infrequent diseases, which poses significant challenges to cost-effective research in the field. Medical registries are being increasingly recognized as crucial tools to provide high-quality data, thus enabling prospective clinical research. This paper describes the design and technical structure development of an innovative countrywide electronic medical record for uveitis, Uveite.pt, and gives an overview of the cohort registered since its foundation, March 2020.Uveite.pt is an electronic medical record platform developed by the Portuguese Ocular Inflammation Group (POIG), a scientific committee of the Portuguese Ophthalmology Society. This is a nationwide customized web-based platform for uveitis patients useful for both clinical practice and real-world-based research, working as a central repository and reporting tool for uveitis. This paper describes the technical principles, the design and the development of a web-based interoperable registry for uveitis in Portugal and provides an overview of more than 400 patients registered in the first 18 months since inception.In infrequent diseases, the existence of registries enables to gather evidence and increase research possibilities to clinicians. The adoption of this platform enables standardization and improvement of clinical practice in uveitis. It is useful to apprehend the repercussion of medical and surgical treatments in uveitis and scleritis, supporting clinicians in the strict monitoring of drug adverse reactions and surgical outcomes.
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Affiliation(s)
- Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vanda Nogueira
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Diogo Bernardo Matos
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Araújo
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Olga Berens
- Ophthalmology Department, Hospital do Espírito Santo, Évora, Portugal
| | - Margarida Ribeiro
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria João Furtado
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Marco Liverani
- Ophthalmology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Marta Inês Silva
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Marta Guedes
- Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Cordeiro
- Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Ribeiro
- Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Patrícia José
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Rafael Barão
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Rui Nunes Ferreira
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Fonseca
- Ophthalmology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sofia Mano
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Pina
- Ophthalmology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria José Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Cristina Fonseca
- Ophthalmology Department, Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Figueira
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP) of the University of Porto, Porto, Portugal
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Zimmermann JA, Storp JJ, Dicke C, Leclaire MD, Eter N. [Frequency and distribution of the active agent of intravitreal injections in German centers 2015-2021-An oregis study]. DIE OPHTHALMOLOGIE 2024; 121:196-206. [PMID: 38315190 DOI: 10.1007/s00347-024-01986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/09/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Digitalization in medicine, especially the electronic documentation of patient data, is revolutionizing healthcare systems worldwide. The evaluation of real-world data collected under everyday conditions presents opportunities but also challenges. Electronic medical registries provide a means to compile extensive patient data for scientific inquiries. Oregis is the first nationwide digital registry for health services research established by the German Ophthalmological Society (DOG). Intravitreal operative medicinal injections (IVOM) are among the most frequently performed procedures in ophthalmology. Data on injection numbers and injection frequencies with anti-vascular endothelial growth factor (VEGF) are already available from other countries, whereas data at a national level are not yet available in Germany due to the lack of a nationwide register. It is known that the treatment success of anti-VEGF IVOMs depends largely on the adherence to treatment and thus on the number of injections. There are also differences in cost. In the context of this study, real-world data on the frequency and distribution of intravitreal injections in German centers from 2015 to 2021 were compiled for the first time since the introduction of oregis. The aim of this study is to collect data on the use of anti-VEGF IVOMs in Germany from oregis for the first time and to show the development of injection numbers and anti-VEGF drugs used. At the same time, the possibilities of data retrieval from oregis are demonstrated using a concrete example from daily ophthalmological practice. MATERIAL AND METHODS An automated query of records was performed for all patients who received IVOM at oregis-affiliated healthcare facilities between 2015 and 2021. The number of treated patients and the use of anti-VEGF medications, including aflibercept, bevacizumab, brolucizumab, and ranibizumab, were determined. The data were collected in a pseudonymized and anonymized manner. RESULTS At the time of data collection, 9 German ophthalmological healthcare facilities were affiliated with oregis. In total, 309,152 patients were registered during the observation period, with 8474 receiving IVOMs. Over the observation period, the number of participating centers, patients, and intravitreal injections increased. The proportional share of anti-VEGF agents among the total number of injections varied during the observation period. DISCUSSION Real-world data captured in oregis offer significant potential for enhancing healthcare provision. Oregis enables the depiction of ophthalmological care conditions in Germany and contributes to research and quality assurance. The ability to query the presented data exemplifies the multitude of inquiries through which oregis can contribute to the representation of ophthalmological care in Germany.
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Affiliation(s)
| | - Jens Julian Storp
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Christopher Dicke
- oregis, Projektmanagement, Deutsche Ophthalmologische Gesellschaft, München, Deutschland
| | - Martin Dominik Leclaire
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
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9
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Akbarian S, Sheikhtaheri A, Khorrami F, Ghahvechian H, Karimi N, Kashkouli MB. Implementation of thyroid eye disease registry in Iran: rationale and research protocol. Orphanet J Rare Dis 2024; 19:42. [PMID: 38321499 PMCID: PMC10845661 DOI: 10.1186/s13023-024-03053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND To describe the implementation of a registry system for patients with thyroid eye disease (TED) in Iran to obtain more information about its nature, prevalence, and annual incidence, as well as extend insight into the etiology, pathogenesis, and eventually make an accurate prognosis of different medical or surgical treatment methods. METHODS After receiving approval from the Disease Registry Committee of Iran University of Medical Sciences (IUMS) in 2019 and the Ministry of Health and Medical Education (MOHME) in 2020, the protocol was introduced in three consecutive phases at regional, provincial and national levels. The establishment of a registry committee in Rassoul Akram Hospital, one of the medical centers affiliated to IUMS, was the first step to organizing the registry project's main core. The steering committee included six subgroups of required subject fields. The members are experts in developing a guideline, providing a new dataset, drawing an outline for the next steps, and structuring user-friendly software through several panel discussion meetings. The data is collected from clinical and para-clinical/imaging findings, laboratory evaluations, and their selected treatment strategy, retrospectively and prospectively. RESULTS The purpose is to broaden our knowledge about the profile of TED; accordingly, data related to patients' demographics, thyroid gland disease (status, duration, treatments, and function tests), general medical and ocular history, along with visual/ocular exams resulting TED status are collected and recorded in a 2- language software. The web-based software system is accessible at https://orc.iums.ac.ir . To maintain data security, prioritized user access was defined for different members. Furthermore, diverse methods, such as employing trained staff and utilizing software validation rules, were implemented to control data quality in every step of data collection, entry, and registration. Medical records of retrospective subjects were also evaluated and entered after accuracy verification. CONCLUSION Iran's TED registry provides practitioners with comprehensive data on natural history and phenotype variations in clinical features and outcomes. It facilitates patient recruitment and, consequently, earlier diagnosis on a large scale which helps improve treatment and quality of life for patients.
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Affiliation(s)
- Shadi Akbarian
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Khorrami
- Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein Ghahvechian
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran
| | - Nasser Karimi
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Skull Base Research Center, Eye Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Rassoul Akram Hospital, Tehran, Tehran, 1465544814, Iran.
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10
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Androudi S, Apivatthakakul A, Arevalo FJ, Berkenstock MK, Carreño E, Chee SP, Choovuthayakorn J, Cimino L, Cornish EE, Farrall AL, Gehl Z, Gentile P, Gerges TK, Gozzi F, Hernández-Pons A, Issa S, Kim HM, Kim M, Knickelbein JE, Kunavisarut P, Lee SM, Lim LL, Lin ML, Llorenç V, López-Sierra S, Martínez-Costa L, McCluskey P, Mochizuki M, O'Day RF, Pai AS, Palestine AG, Pathanapitoon K, Radford MH, Silpa-Archa S, Smith JR, Terada Y, Waduthantri S, Weaver TR, Williams KL, Woo SJ, Younan C. Presentation, Diagnostic Testing and Initial Treatment of Vitreoretinal Lymphoma. Ophthalmol Retina 2024; 8:72-80. [PMID: 37648063 DOI: 10.1016/j.oret.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Vitreoretinal lymphoma is a malignancy with high mortality. Incidence is rare, and there is a lack of medical evidence to direct management. This work describes presentation, diagnostic testing, and first treatment approaches in a recently diagnosed and treated patient cohort. DESIGN Clinical registry-based observational study. SUBJECTS Forty-eight women and 32 men (age range, 32-91 years; median age, 64 years) diagnosed with vitreoretinal lymphoma. METHODS An international network of ophthalmologists reported clinical features and management of patients presenting with vitreoretinal lymphoma between January 1, 2020 and December 31, 2022 via an electronic platform. MAIN OUTCOME MEASURES Visual acuity at presentation (logarithm of the minimum angle of resolution [logMAR]); basis for diagnosis; first treatment. RESULTS Vitreoretinal lymphoma was bilateral at presentation in 65% of patients (n = 52) and an initial site of lymphoma in 78% (n = 62). Of 127 eyes with lymphoma at presentation, vitreous was involved in 89% (n = 113) and was the only involved eye tissue in 40% (n = 51), and retina was involved in 46% (n = 59) and was the only involved eye tissue in 9% (n = 11). Median logMAR visual acuity of the worse-seeing eye was 0.50. The lymphoma was diagnosed from ocular specimens in 80% of patients (64/80), usually vitreous (57/64 patients [89%]), and on other clinical information in 20% of patients (16/80). Cellular studies were performed on ocular specimens from 59 of 64 patients (92%), most often cytology. Tumor gene analysis was used in 21 of 64 patients (33%), and cytokine assays were used in 13 of 64 patients (20%). For 76 patients (95%), treatment was initiated within 6 months of diagnosis and included ocular (38/76 [48%]), extraocular (17/76 [21%]), and ocular plus extraocular (21/76 [26%]) approaches. Intravitreal methotrexate was the most common ocular treatment (83/87 eyes [95%]). CONCLUSIONS Using data collected from 80 patients diagnosed with vitreoretinal lymphoma since 2020, we show that visual impairment is common, and that management often involves diagnosis by cellular tests and treatment with intravitreal chemotherapy. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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11
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Zhang Z, Ng Ming Sheng S, Kempen JH, Fabiani C, Arora A, Gupta V, Tsui E, Cimino L, Symes RJ, Dell J, Finger RP, Heinz C, Agrawal R. Uveitis Registries - A Digital Tool for Patient Care, Education, Research, and Collaboration. Ocul Immunol Inflamm 2023; 31:1859-1869. [PMID: 36328530 DOI: 10.1080/09273948.2022.2140062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Clinical registries are increasingly important in research and clinical advancement. This review explores and compares current uveitis registries and recommends future directions on how uveitis registries can complement one another for synergistic effect and benefit. METHODS From a systematic search, 861 citations were screened for longitudinal, non-interventional, and multicenter uveitis-specific registries. Additional registries were identified via consultations with uveitis experts. Characteristics of all registries were analyzed and compared. RESULTS Four registries were identified: Treatment Exit Options for Non-infectious Uveitis, AutoInflammatory Disease Alliance International Registry, Ocular Autoimmune Systemic Inflammatory Infectious Study, and Fight Uveitis Blindness!. Despite certain differences, these registries have the overarching goal of collecting large quantities of real-world, high-quality patient data to improve the understanding of uveitis. CONCLUSION The four uveitis registries share similar goals and collect clinical data from overlapping geographical regions. There is vast potential for collaboration, including data sharing to further augment datasets for analysis.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean Ng Ming Sheng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Boston Massachusetts, USA
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Bellevue, Washington, USA
| | - Claudia Fabiani
- Ophthalmology Unit,Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Atul Arora
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, California, USA
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Richard J Symes
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Ng SMS, Low R, Pak C, Lai S, Lee B, McCluskey P, Symes R, Invernizzi A, Tsui E, Sitaula RK, Kharel M, Khatri A, Utami AN, La Distia Nora R, Putera I, Sen A, Agarwal M, Mahendradas P, Biswas J, Pavesio C, Cimino L, Sobrin L, Kempen JH, Gupta V, Agrawal R. The role of a multicentre data repository in ocular inflammation: The Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS). Eye (Lond) 2023; 37:3084-3096. [PMID: 36918629 PMCID: PMC10564879 DOI: 10.1038/s41433-023-02472-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
In the current literature, clinical registry cohorts related to ocular inflammation are few and far between, and there are none involving multi-continental international data. Many existing registries comprise administrative databases, data related to specific uveitic diseases, or are designed to address a particular clinical problem. The existing data, although useful and serving their intended purposes, are segmented and may not be sufficiently robust to design prognostication tools or draw epidemiological conclusions in the field of uveitis and ocular inflammation. To solve this, we have developed the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) Clinical Registry. OASIS collects prospective and retrospective data on patients with all types of ocular inflammatory conditions from centers all around the world. It is a primarily web-based platform with alternative offline modes of access. A comprehensive set of clinical data ranging from demographics, past medical history, clinical presentation, working diagnosis to visual outcomes are collected over a range of time points. Additionally, clinical images such as optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography studies may be uploaded. Through the capturing of diverse, well-structured, and clinically meaningful data in a simplified and consistent fashion, OASIS will deliver a comprehensive and well organized data set ripe for data analysis. The applications of the registry are numerous, and include performing epidemiological analysis, monitoring drug side effects, and studying treatment safety efficacy. Furthermore, the data compiled in OASIS will be used to develop new classification and diagnostic systems, as well as treatment and prognostication guidelines for uveitis.
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Affiliation(s)
- Sean Ming Sheng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Clara Pak
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - SerSei Lai
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Richard Symes
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Alessandro Invernizzi
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA
| | - Ranju Kharel Sitaula
- Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Muna Kharel
- Nepal Army Institute of Health Sciences, Kathmandu, Nepal
| | | | | | | | | | - Alok Sen
- Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Ophthalmology, Dr Shroff's Charity Eye Hospital Daryaganj, New Delhi, India
| | | | | | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, 42121, Reggio Emilia, Italy
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, MA, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Fort Myers, FL, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
- Singapore Eye Research Institute, The Academia, Singapore, Singapore.
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Khan MA, Sartor L, Seyed-Razavi Y, Samarawickrama C. Combine and conquer: The case for an Australian and New Zealand cataract surgery registry. Clin Exp Ophthalmol 2023; 51:642-643. [PMID: 37211414 DOI: 10.1111/ceo.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Muhammad A Khan
- Department of Ophthalmology, University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
- Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute of Medical Research, Sydney, New South Wales, Australia
| | - Lauren Sartor
- Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
- Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute of Medical Research, Sydney, New South Wales, Australia
| | - Yashar Seyed-Razavi
- Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute of Medical Research, Sydney, New South Wales, Australia
| | - Chameen Samarawickrama
- Department of Ophthalmology, University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
- Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute of Medical Research, Sydney, New South Wales, Australia
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14
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Storp JJ, Dicke C, Böhringer D, Schargus M, Eter N. [oregis-The German ophthalmological registry]. DIE OPHTHALMOLOGIE 2023; 120:717-725. [PMID: 36635592 DOI: 10.1007/s00347-022-01804-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Medical registries have shown their potential for medical research in different areas of healthcare in the past. The United States of America uses the well-known national ophthalmology registry Intelligent Research in Sight (IRIS®), on the basis of which insights into the ophthalmological care situation in the USA can be gained. Comparable projects do not currently exist in Germany. The oregis is the first disease-independent registry to collect comprehensive data in the field of ophthalmology in Germany for the purpose of healthcare research. METHODS The oregis collects anonymized clinical patient information from all subfields of ophthalmology and makes it available for research purposes. Participating centers read their data into the registry free of charge and preferably in an automated fashion. Currently, the oregis parameter list contains about 600 parameters, of which about 100 are used in the current pilot phase. RESULTS Since its initiation, the German ophthalmological registry oregis has compiled data on more than 1.75 million physician visits for more than 400,000 patients from German ophthalmologic centers. As of late 2022, more than 2.8 million visual acuity measurements and an equal number of intraocular pressure measurements have been recorded. DISCUSSION The aim of the oregis project is to establish a nationwide ophthalmology databank that forms the basis for a learning healthcare system in the field of ophthalmology. With the help of continuous updating, oregis can also illustrate short-term innovations in ophthalmological care.
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Affiliation(s)
- Jens Julian Storp
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland.
| | - Christopher Dicke
- oregis, Projektmanagement, Deutsche Ophthalmologische Gesellschaft, München, Deutschland
| | - Daniel Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Marc Schargus
- Klinik für Augenheilkunde, Asklepios Klinik Nord-Heidberg, Hamburg, Deutschland
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
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15
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Ting DSJ, Deshmukh R, Ting DSW, Ang M. Big data in corneal diseases and cataract: Current applications and future directions. Front Big Data 2023; 6:1017420. [PMID: 36818823 PMCID: PMC9929069 DOI: 10.3389/fdata.2023.1017420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
The accelerated growth in electronic health records (EHR), Internet-of-Things, mHealth, telemedicine, and artificial intelligence (AI) in the recent years have significantly fuelled the interest and development in big data research. Big data refer to complex datasets that are characterized by the attributes of "5 Vs"-variety, volume, velocity, veracity, and value. Big data analytics research has so far benefitted many fields of medicine, including ophthalmology. The availability of these big data not only allow for comprehensive and timely examinations of the epidemiology, trends, characteristics, outcomes, and prognostic factors of many diseases, but also enable the development of highly accurate AI algorithms in diagnosing a wide range of medical diseases as well as discovering new patterns or associations of diseases that are previously unknown to clinicians and researchers. Within the field of ophthalmology, there is a rapidly expanding pool of large clinical registries, epidemiological studies, omics studies, and biobanks through which big data can be accessed. National corneal transplant registries, genome-wide association studies, national cataract databases, and large ophthalmology-related EHR-based registries (e.g., AAO IRIS Registry) are some of the key resources. In this review, we aim to provide a succinct overview of the availability and clinical applicability of big data in ophthalmology, particularly from the perspective of corneal diseases and cataract, the synergistic potential of big data, AI technologies, internet of things, mHealth, and wearable smart devices, and the potential barriers for realizing the clinical and research potential of big data in this field.
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Affiliation(s)
- Darren S. J. Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom,Birmingham and Midland Eye Centre, Birmingham, United Kingdom,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom,*Correspondence: Darren S. J. Ting ✉
| | - Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Daniel S. W. Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
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16
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Garavand A, Rabiei R, Emami H. Design and Development of a Hospital-Based Coronary Artery Disease (CAD) Registry in Iran. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3075489. [PMID: 36743517 PMCID: PMC9891832 DOI: 10.1155/2023/3075489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
Background The incidence of coronary artery disease (CAD), the leading cause of mortality in most developed and developing countries, is increasing. The adoption of hospital registries can improve care delivery and facilitate the management of CAD through better planning, as well as help with outcome assessment through more effective data management. Objectives The present study is aimed at designing a hospital-based CAD registry for managing CAD data. Methods This developmental study was conducted in three phases. Initially, sources related to CAD registries were reviewed, the results of which were published in two studies. In the next phase, the prerequisites and requisites of the software were determined through a qualitative study. In this phase, the registry dataset was determined by using a questionnaire. Finally, the developed conceptual model of the software was validated. The software was then developed based on the validated conceptual model. Results The registry data elements were classified into 13 main categories, including identification data, medical history, and risk factors. The dataset included 171 data elements, including data related to surgical and nonsurgical procedures. The conceptual model was approved by field experts, and the software was developed accordingly. Conclusion The steps followed in the present study for developing the CAD registry can be used as an appropriate approach for designing similar hospital-based registries. Considering the pivotal role of the registry in the management of CAD, the routine and systemic use of the registry is suggested in all healthcare centers.
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Affiliation(s)
- Ali Garavand
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Emami
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Chu HS, Hu FR, Liu HY, Srikumaran D. Keratoplasty Registries: Lessons Learned. Cornea 2023; 42:1-11. [PMID: 36459579 DOI: 10.1097/ico.0000000000003088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
ABSTRACT Clinical registries have been developed for decades in the field of ophthalmology, and they are especially well-suited to the study of keratoplasty practices. A comprehensive donor/recipient registry system can provide insight into donor, recipient, and surgical factors associated with immediate and long-term outcomes and adverse reactions. Furthermore, linkage with demographic databases can elucidate relationships with social determinants of health and potentially shape public policy. The vast sample size and multicenter nature of registries enable researchers to conduct sophisticated multivariate or multilayered analyses. In this review, we aim to emphasize the importance of registry data for keratoplasty practice and 1) summarize the structure of current keratoplasty registries; 2) examine the features and scientific contributions of the registries from Australia, the United Kingdom, Singapore, the Netherlands, Sweden, Eye Bank Association of America, and European Cornea and Cell Transplant registries; 3) compare registry-based studies with large single-site clinical studies; 4) compare registry-based studies with randomized control studies; and 5) make recommendations for future development of keratoplasty registries. Keratoplasty registries have increased our knowledge of corneal transplant practices and their outcomes. Future keratoplasty registry-based studies may be further strengthened by record linkage, data sharing, and international collaboration.
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Affiliation(s)
- Hsiao-Sang Chu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; and
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei, Taiwan
| | - Hsin-Yu Liu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; and
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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18
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Xu TT, Bothun CE, Hendricks TM, Mansukhani SA, Bothun ED, White LJ, Mohney BG. Accuracy of the International Classification of Diseases, 9th Revision for Identifying Infantile Eye Disease. Ophthalmic Epidemiol 2022; 29:649-655. [PMID: 34821545 PMCID: PMC9130338 DOI: 10.1080/09286586.2021.2009520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses. METHODS Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. RESULTS In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p < .001), pseudostrabismus (85.9% vs. 25.0%, p < .001), and physiologic anisocoria (95.5% vs. 33.3%, p = .002). CONCLUSION The predictive value of ICD-9 codes for capturing infantile ocular diagnoses varied widely in this cohort. These findings emphasize the limitations of database research methodologies that solely utilize claims data to identify pediatric eye diseases.Abbreviations/Acronyms PPV: positive predictive value; NPV: negative predictive value; CNLDO: congenital nasolacrimal duct obstruction.
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Affiliation(s)
- Timothy T. Xu
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Cole E. Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Erick D. Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Launia J. White
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Brian G. Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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19
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Clinical Registries in Dry Eye Disease: A Systematic Review. Cornea 2022; 41:1572-1583. [DOI: 10.1097/ico.0000000000003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/19/2022] [Indexed: 11/25/2022]
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20
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Bergeron E, Kyrillos R, Laughrea PA. Review of Corneal Graft Registries. Cornea 2022; 41:1196-1202. [PMID: 35942548 DOI: 10.1097/ico.0000000000003076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Corneal graft registries are organized systems that collect and analyze outcome data (such as long-term graft survival and visual outcomes) after keratoplasty procedures. The aim of this review was to identify existing corneal graft registries and to describe their characteristics. METHODS A search of the PubMed database was performed on June 1, 2021, for articles pertaining to corneal graft registries. RESULTS The PubMed literature search yielded 958 publications, of which 116 met all the inclusion and exclusion criteria. Among these articles, 15 corneal graft registries were identified, including 6 regional registries, 8 national registries, and 1 multinational registry. This article provides an overview of their characteristics and discusses the main advantages and pitfalls of clinical registries. CONCLUSIONS Clinical registry data are increasingly recognized as a valuable tool to monitor corneal transplant outcomes to improve health care services and optimize resource management.
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Affiliation(s)
- Emilie Bergeron
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, Canada
- Service d'ophtalmologie pédiatrique, Centre Hospitalier de l'Université Laval, CHU de Québec-Université Laval, Quebec City, Canada
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Quebec City, Canada
- CUO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada ; and
| | - Ralph Kyrillos
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, Canada
- Service d'ophtalmologie pédiatrique, Centre Hospitalier de l'Université Laval, CHU de Québec-Université Laval, Quebec City, Canada
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Quebec City, Canada
- CUO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada ; and
- Banque d'yeux du Centre Universitaire d'Ophtalmologie, CHU de Québec-Université Laval, Quebec City, Canada
| | - Patricia-Ann Laughrea
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, Canada
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Quebec City, Canada
- CUO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada ; and
- Banque d'yeux du Centre Universitaire d'Ophtalmologie, CHU de Québec-Université Laval, Quebec City, Canada
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21
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Musch DC, Chew EY. Evidence for Step Therapy in Diabetic Macular Edema. N Engl J Med 2022; 387:751-752. [PMID: 35833808 PMCID: PMC11330691 DOI: 10.1056/nejme2208454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David C Musch
- From the Department of Ophthalmology and Visual Sciences, Medical School, and the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (D.C.M.); and the Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD (E.Y.C.)
| | - Emily Y Chew
- From the Department of Ophthalmology and Visual Sciences, Medical School, and the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (D.C.M.); and the Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD (E.Y.C.)
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22
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Watson S. Automated dry eye diagnostics: Are they ready for the clinic? Clin Exp Ophthalmol 2022; 50:585-586. [DOI: 10.1111/ceo.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie Watson
- Faculty of Medicine and Health, Save Sight Institute The University of Sydney Sydney New South Wales Australia
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23
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Smith JR, Farrall AL, Davis JL, de Boer JH, Hall AJ, Mochizuki M, Sen HN, Takase H, Ten Dam-van Loon NH, Touitou V, Vasconcelos-Santos DV, Wilson DJ, Yeh S, Radford MHB. The International Vitreoretinal B-Cell Lymphoma Registry: a protocol paper. BMJ Open 2022; 12:e060701. [PMID: 35902200 PMCID: PMC9341180 DOI: 10.1136/bmjopen-2021-060701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Vitreoretinal lymphoma is a rare ocular cancer with high morbidity and mortality despite treatment. Diagnosis by cytopathology is often delayed, and various molecular and image-based investigations have been developed. Diverse treatments are used, but there is a limited medical evidence to differentiate their effectiveness. We designed an international registry that would collect diagnostic, treatment and outcomes data, to establish new evidence for the management of this cancer. METHODS AND ANALYSIS The International Vitreoretinal B-Cell Lymphoma Registry will accrue data retrospectively for individuals aged 18 years or older, diagnosed with new or recurrent vitreoretinal B-cell lymphoma on or after 1 January 2020. A steering committee of subspecialised ophthalmologists identified 20 key clinical data items that describe patient demographics, tissue involvements, diagnostic testing, ocular and systemic treatments and treatment complications, and visual acuity and survival outcomes. Customised software was designed to permit collection of these data across a single baseline and multiple follow-up forms. The platform collects data without identifiers and at 3 month reporting intervals. Outcomes of the project will include: (1) descriptions of clinical presentations, and diagnostic and therapeutic preferences; (2) associations between clinical presentations, and diagnostics and treatments, and between diagnostics and treatments (assessed by ORs with 95% CIs); and (3) estimations of rates of vision loss, and progression-free and overall survival (assessed by Kaplan-Meier estimates). ETHICS AND DISSEMINATION The registry has received Australia-wide approval by a national human research ethics committee. Sites located outside Australia are required to seek local human research ethics review. Results generated through the registry will be disseminated primarily by peer-reviewed publications that are expected to inform clinical practice, as well as educational materials.
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Affiliation(s)
- Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Queensland Eye Institute, Brisbane, Queensland, Australia
| | - Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Joke H de Boer
- Department of Ophthalmology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Health, Melbourne, Victoria, Australia
| | - Manabu Mochizuki
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hiroshi Takase
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Valérie Touitou
- Department of Ophthalmology, Sorbonne University, Hospital Pitié Salpêtrière, Paris, France
| | | | - David J Wilson
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Steven Yeh
- Cancer Immunology Research Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark H B Radford
- Queensland Eye Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, George E Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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24
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Aghayeva FA, Schuster AK, Diel H, Chronopoulos P, Wagner FM, Grehn F, Pirlich N, Schweiger S, Pfeiffer N, Hoffmann EM. Childhood glaucoma registry in Germany: initial database, clinical care and research (pilot study). BMC Res Notes 2022; 15:32. [PMID: 35144644 PMCID: PMC8830121 DOI: 10.1186/s13104-022-05921-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this prospective pilot study is to establish an initial database to register patients diagnosed with different types of childhood glaucoma and the set-up of a national registry for childhood glaucoma (ReCG) in Germany. 28 children with different types of diagnosed childhood glaucoma, who were admitted and treated at the Childhood Glaucoma Center of the University Medical Center Mainz, Germany were included. Main outcome measures were the type of childhood glaucoma, mean intraocular pressure (IOP) and genetic data of the patients. Results The documents and questionnaires for each individual included: informed consent form of the parents, medical history form of the child, patient’s gestational history questionnaire and general anesthesia examination form. Primary congenital and secondary childhood glaucoma were revealed in 11 (39%) and 17 (61%) patients, respectively. The mean IOP measured with Perkins tonometer in all patients under general anesthesia at the time of inclusion was 17.5 ± 11.8 mmHg in the right and 17 ± 8.9 mmHg in the left eyes. In 33% of children with glaucoma mutations in the CYP1B1, FOXC1, LTBP2 and TEK genes were found. The development of specific questionnaires for childhood glaucoma provides detailed baseline data to establish a ReCG in Germany for the first time. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05921-8.
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Affiliation(s)
- Fidan A Aghayeva
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,National Centre of Ophthalmology Named After Academician Zarifa Aliyeva, Baku, Azerbaijan
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Heidi Diel
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Panagiotis Chronopoulos
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Felix M Wagner
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Franz Grehn
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,Department of Ophthalmology, University Medical Center Würzburg, Würzburg, Germany
| | - Nina Pirlich
- Department of Anaesthesiology, University Medical Center of the Johannes Gutenberg, University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Susann Schweiger
- Institute of Human Genetics, University Medical Centre of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.
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Ng SMS, Low R, Hoskin AK, Rousselot A, Gunasekeran DV, Natarajan S, Sundar G, Chee CKL, Mishra C, Sen P, Pradhan E, Irawati Y, Kamalden TA, Shah M, Yan H, Woreta FA, Subramanian PS, Kuhn F, Watson SL, Agrawal R. The application of clinical registries in ophthalmic trauma-the International Globe and Adnexal Trauma Epidemiology Study (IGATES). Graefes Arch Clin Exp Ophthalmol 2021; 260:1055-1067. [PMID: 34812939 DOI: 10.1007/s00417-021-05493-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The prevalence of ophthalmic trauma varies considerably based on geographic location, socio-economic status, age groups, occupation, and cultural practices such as firework celebrations. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. However, there is currently a lack of a centralized international data repository for ophthalmic trauma. We draw lessons from past and existing clinical registries related to ophthalmology and propose a new suitable international multicenter clinical registry for ophthalmic trauma: the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES is hosted on a secure web-based platform which exhibits user-friendly smart features, an integrated Ocular Trauma Score (OTS) prognosis calculator, efficient data collection points, and schematic graphical software. IGATES currently has 37 participating centers globally. The data collected through IGATES will be primarily used to develop a more robust and improved ophthalmic trauma prognostic classification system, the Ocular Trauma Score-2 (OTS-2), which builds on previous systems such as the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Furthermore, IGATES will act as a springboard for further research into the epidemiology, diagnosis, and management of ophthalmic trauma. Ultimately, IGATES serves to advance the field of ophthalmic trauma and improve the care that patients with ophthalmic trauma receive.
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Affiliation(s)
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, 308433, Singapore
| | - Annette K Hoskin
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Andres Rousselot
- Consultorios Oftalmológicos Benisek Ascarza, Capital Federal, Argentina
| | | | | | - Gangadhara Sundar
- National University Hospital, National University of Singapore, Singapore, Singapore
| | - Caroline Ka Lin Chee
- National University Hospital, National University of Singapore, Singapore, Singapore
| | | | | | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | | | | | - Mehul Shah
- Drashti Netralaya Eye Hospital, Dahod, India
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, USA
- Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Singapore, Singapore.
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, 308433, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore.
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Hoskin AK, Low R, de Faber JT, Mishra C, Susvar P, Pradhan E, Rousselot A, Woreta FA, Keay L, Watson SL, Agrawal R. Eye injuries from fireworks used during celebrations and associated vision loss: the international globe and adnexal trauma epidemiology study (IGATES). Graefes Arch Clin Exp Ophthalmol 2021; 260:371-383. [PMID: 34453604 DOI: 10.1007/s00417-021-05284-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report on the factors associated with severe vision loss from fireworks-related ocular trauma during celebrations, including festivals. METHODS Tertiary eye care hospitals in 5 countries and private ophthalmology practices in the Netherlands. Patients included received treatment for fireworks-related ocular trauma during celebrations. Demographic and clinical data for patients affected were analyzed and associations with severe vision loss reported. RESULTS Of 388 patients, 71 (18.3 %) had severe vision loss (worse than 6/60) at 4-week follow-up due to fireworks-related ocular trauma. Mean age overall was 20.6 years (range 2 to 83 years), and there was a male predominance of 4:1. Clinical factors associated with severe vision loss included penetrating injury (OR 4.874 [95% CI 1.298-18.304; p = 0.02]) and lens injury (OR 7.023 [95% CI 2.378-20.736; p = 0.0004]). More patients with closed-globe injuries (CGIs) had improved vision after 4 weeks (OR 3.667, 1.096-12.27) compared to those with open-globe injuries (OGI) (p = 0.035). Eye protection use was reported by 7 patients, and 39.4% patients < 18 years were unsupervised by an adult at the time of injury. CONCLUSIONS Severe vision loss from fireworks-related ocular trauma occurred during celebrations in a variety of countries and was associated with penetrating and/or lens injury and poor presenting vision. New initiatives are needed to prevent severe vision loss associated with these injuries.
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Affiliation(s)
- Annette K Hoskin
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Rebecca Low
- National Healthcare Group Eye Institute at Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | | | | | | | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Andres Rousselot
- Ophthalmology Department, Universidad del Salvador, Buenos Aires, Argentina
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW, Sydney, Australia.,The George Institute for Global Health, UNSW, Sydney, Australia
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute at Tan Tock Seng Hospital, Singapore, 308433, Singapore.
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Dunker SL, Armitage WJ, Armitage M, Brocato L, Figueiredo FC, Heemskerk MBA, Hjortdal J, Jones GLA, Konijn C, Nuijts RMMA, Lundström M, Dickman MM. Practice patterns of corneal transplantation in Europe: first report by the European Cornea and Cell Transplantation Registry. J Cataract Refract Surg 2021; 47:865-869. [PMID: 33577274 DOI: 10.1097/j.jcrs.0000000000000574] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report practice patterns of corneal transplantation in Europe. SETTING Corneal clinics in 10 European member states (MS), the United Kingdom, and Switzerland. DESIGN Multinational registry study. METHODS Corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry were identified. Preoperative donor and recipient characteristics, indication and reason for transplantation, and surgical techniques were analyzed. RESULTS A total of 12 913 corneal transplants were identified from 10 European Union MS, the United Kingdom, and Switzerland. Most countries were self-sufficient with regard to donor tissue. Fuchs endothelial corneal dystrophy was the most common indication (41%, n = 5325), followed by regraft (16%, n = 2108), pseudophakic bullous keratopathy (12%, n = 1594), and keratoconus (12%, n = 1506). Descemet stripping automated endothelial keratoplasty (DSAEK, 46%, n = 5918) was the most commonly performed technique, followed by penetrating keratoplasty (30%, n = 3886) and Descemet membrane endothelial keratoplasty (9%, n = 1838). Vision improvement was the main reason for corneal transplantation (90%, n = 11 591). Surgical technique and reason for transplantation differed between indications. CONCLUSIONS This report provides the most comprehensive overview of corneal transplantation practice patterns in Europe to date. Fuchs endothelial dystrophy is the most common indication, vision improvement the leading reason, and DSAEK the predominant technique for corneal transplantation.
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Affiliation(s)
- Suryan L Dunker
- From the University Eye Clinic, Maastricht University Medical Center+, The Netherlands (Dunker, Nuijts, Dickman); Translational Health Sciences, University of Bristol, United Kingdom (Armitage); Tissue and Eye Services, NHS Blood and Transplant, Bristol, United Kingdom (Armitage); European Eye Bank Association, Venice, Italy (Armitage, Jones); Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden (Armitage); European Society of Cataract and Refractive Surgeons, Dublin, Ireland (Brocato, Nuijts, Lundström); Department of Ophthalmology, Royal Victoria Infirmary and Newcastle University, Newcastle upon Tyne, United Kingdom (Figueiredo); Dutch Transplant Foundation, Leiden, The Netherlands (Heemskerk, Konijn); Department of Ophthalmology, Aarhus University Hospital, Denmark (Hjortdal); European Society of Cornea and Ocular Surface Disease Specialists, Dublin, Ireland (Hjortdal); The Veneto Eye Bank Foundation, Venice, Italy (Jones); Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden (Lundström)
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Hoskin AK, Low R, Sen P, Mishra C, Kamalden TA, Woreta F, Shah M, Pauly M, Rousselot A, Sundar G, Natarajan S, Keay L, Gunasekeran DV, Watson SL, Agrawal R. Epidemiology and outcomes of open globe injuries: the international globe and adnexal trauma epidemiology study (IGATES). Graefes Arch Clin Exp Ophthalmol 2021; 259:3485-3499. [PMID: 34173879 DOI: 10.1007/s00417-021-05266-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To detail the methodology for a novel ocular trauma registry and utilize the registry to determine the demographics, nature of injury, and associations of severe visual loss for open globe injuries (OGI). METHODS Thirteen hospitals in 7 countries used International Globe and Adnexal Trauma Epidemiology Study (IGATES) platform. Patients presenting between April 2009 and 2020 with OGI (with or without) adnexal involvement or intraocular foreign body (IOFB) were included. RESULTS Analyses of presenting and final VA, using "severe vision loss" (VA ≤ 6/60) and "no severe loss" (VA > 6/60), were performed. Four hundred fifty-four (64%) patients had VA < 6/60 at presentation and 327 (44.8%) at final follow-up, with a highly significant association between presenting and final VA (p < 0.0001). From the cohort of 746 patients, 37 were missing VA at presentation and 16 at follow-up and complete clinical data was available for 354 patients. The male to female ratio is 6:1, and mean age 36.0 ± 20.0 years old. Relative afferent pupillary defect (RAPD), zone III injury, IOFB, and eyelid injury at presentation were recorded in 50 (6.7%), 55 (7.8%), 97 (13%), and 87 (11.7%) patients, respectively, and were significantly associated with VA < 6/60 at follow-up. Older age, ≥ 61 years, was associated with 3.39 times (95% CI: 1.95-5.89) higher risk than ≤20-year-old patients (p < 0.0001) and males 0.424 times (95% CI: 0.27-0.70) lower risk than female (p = 0.0001) of severe vision loss (SVL). CONCLUSION In OGIs from 13 hospitals, female gender, older age, zone III injury, eyelid injury, and IOFB were associated with higher risk of visual outcome of SVL.
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Affiliation(s)
- Annette K Hoskin
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, 308433, Singapore.,School of Medicine, National University of Singapore, Kent Ridge, Singapore
| | | | | | | | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mehul Shah
- Drashti Nethralaya Eye Hospital, Dahod, India
| | | | - Andres Rousselot
- Consultorios Oftalmológicos Benisek Ascarza, Capital Federal, Buenos Aires, Argentina
| | | | | | - Lisa Keay
- School of Optometry and Vision Science, UNSW, Sydney, Australia.,The George Institute for Global Health, UNSW, Sydney, Australia
| | | | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Novena, 308433, Singapore.
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Kandel H, Downie LE, Watson SL. The Save Sight Keratoconus Registry - Optometry Module: an opportunity to use real-world data to advance eye care. Clin Exp Optom 2021; 105:96-99. [PMID: 34134600 DOI: 10.1080/08164622.2021.1924626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There is increasing focus on the value of real-world clinical registry data in multiple medical disciplines, including ophthalmology. However, disease-focused clinical registries that engage optometrists are rare. This paper introduces the Optometry Module of the Save Sight Keratoconus Registry (SSKR) and highlights the potential advantages it can offer to optometrists for improving their quality of patient care and for engaging in research. Optometrists are primary eye care providers and have a major role in providing clinical care to people with keratoconus. The SSKR system has been developed to collects high-quality information on essential clinical parameters including patient-reported outcomes (i.e., quality of life data). The real-world data from the Optometry Module of the SSKR can be analysed to obtain insights into contemporary optometry keratoconus practice, and be used to identify opportunities for improving clinical care. Optometrists' engagement with the registry supports reflective clinical practice through real-time benchmarking. Optometrists can use the registry system to track patient outcomes, and it provides a framework for educating patients about their keratoconus journey. The system also captures details relating to patient adverse events, with subsequent data analysis enabling risk factors for such events to be identified. In summary, the Optometry Module of the SSKR captures real-world clinical evidence that has the potential to inform practice improvement, facilitate safety surveillance and enable outcomes research in keratoconus, all with the ultimate intent of enhancing care for people living with keratoconus.
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Affiliation(s)
- Himal Kandel
- Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie L Watson
- Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Tognetto D, Giglio R, De Giacinto C, Dell'Aquila C, Pian G, Scardellato C, Piñero DP. Cataract standard set for outcome measures: An Italian tertiary referral centre experience. Eur J Ophthalmol 2021; 32:11206721211018370. [PMID: 34053333 DOI: 10.1177/11206721211018370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementation of the International Consortium for Health Outcomes Measurements (ICHOM) standard for cataract surgery into clinical practice at an Italian tertiary referral centre. METHODS Prospective, observational, descriptive study consisting of the registry and analysis of cataract surgeries performed during a 6-month enrolment period at the University Eye Clinic of Trieste, Trieste, Italy. Outcomes were recorded and analysed according to the ICHOM Cataract Standard Set version 2.0.1. Records included clinician-reported outcome measures (CROMs) - visual outcome and complications - and patient-reported outcome measures (PROMs) - self-assessed vision with the Catquest-9SF questionnaire. Correlations between PROMs and CROMs were evaluated. A multiple linear regression was used for predicting the change in PROMs with surgery. RESULTS A total of 218 eyes (of 218 patients) were analysed. Postoperative corrected distance visual acuity (CDVA) was ⩾0.3 in 89.0% (194/218) of eyes. There was a statistically significant improvement of the post-operative Catquest-9SF global average score. (p < 0.001). The change in the Catquest-9SF score significantly correlated with the change in Item 2 score (related to intermediate vision) (r = 0.634, p < 0.001). A predictive model of the change in the Catquest-9SF score was found (p < 0.001, R2: 0.527) based on preoperative Catquest-9SF total score, presence or not of macular degeneration, presence or not of intraoperative complications, age >75 years old, and preoperative CDVA. CONCLUSIONS Cataract surgery improves the functional vision, with some factors limiting the outcomes such as comorbidities. Self-perceived improvement in intermediate vision significantly influenced the improvement in self-assessed vision.
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Affiliation(s)
- Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Rosa Giglio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara De Giacinto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carmen Dell'Aquila
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Pian
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carlo Scardellato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - David Pablo Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Re: Chen et al.: The United States Eye Injury Registry: past and future directions (Ophthalmology. 2021;128:647-648). Ophthalmology 2021; 128:e33-e34. [PMID: 33840499 DOI: 10.1016/j.ophtha.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
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CLEAR - Contact lens complications. Cont Lens Anterior Eye 2021; 44:330-367. [DOI: 10.1016/j.clae.2021.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
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Ferdi A, Nguyen V, Kandel H, Tan JCK, Arnalich-Montiel F, Abbondanza M, Watson S. Predictors of progression in untreated keratoconus: a Save Sight Keratoconus Registry study. Br J Ophthalmol 2021; 106:1206-1211. [PMID: 33785509 DOI: 10.1136/bjophthalmol-2020-317547] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/08/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
AIMS We set out to identify risk factors for progression in untreated keratoconus patients from 34 centres across Australia, New Zealand, Spain and Italy. METHODS Patients were divided into 'progressors' and 'stable' patients for each clinical parameter: visual acuity (VA), steepest keratometry (maximum keratometry (Max-K)) and thinnest corneal thickness (TCT). Primary outcomes were the proportion of eyes with sustained progression in VA, Max-K or TCT within 3 years. Secondary outcomes included predictors of progression. RESULTS There were 3994 untreated eyes from 2283 patients. The proportion of eyes with VA, Max-K and TCT progression at 1 year were 3.2%, 6.6% and 3.1% respectively. Factors associated with VA loss were higher baseline VA (HR 1.15 per logMAR line increase in VA; p<0.001) and steeper baseline Max-K (HR 1.07 per 1D increase; p<0.001). Younger baseline age was associated with Max-K steepening (HR 0.96 per year older; p=0.001). Thicker baseline TCT, steeper baseline Max-K and younger baseline age were associated with TCT thinning: (HR 1.08 per 10 µm increase in TCT; p<0.001), (HR 1.03 per 1D increase; p=0.02) and (HR 0.98 per year younger; p=0.01), respectively. CONCLUSIONS Steeper Max-K and younger age were the most clinically useful baseline predictors of progression as they were associated with worsening of two clinical parameters. Every 1D steeper Max-K was associated with a 7% and 3% greater risk of worsening VA and thinning TCT, respectively. Each 1 year younger was associated with a 4% and 2% greater risk of steepening Max-K and thinning TCT, respectively.
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Affiliation(s)
- Alex Ferdi
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Himal Kandel
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Jeremy C K Tan
- Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | | | - Stephanie Watson
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
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Mun Y, Kim J, Noh KJ, Lee S, Kim S, Yi S, Park KH, Yoo S, Chang DJ, Park SJ. An innovative strategy for standardized, structured, and interoperable results in ophthalmic examinations. BMC Med Inform Decis Mak 2021; 21:9. [PMID: 33407448 PMCID: PMC7789748 DOI: 10.1186/s12911-020-01370-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although ophthalmic devices have made remarkable progress and are widely used, most lack standardization of both image review and results reporting systems, making interoperability unachievable. We developed and validated new software for extracting, transforming, and storing information from report images produced by ophthalmic examination devices to generate standardized, structured, and interoperable information to assist ophthalmologists in eye clinics. RESULTS We selected report images derived from optical coherence tomography (OCT). The new software consists of three parts: (1) The Area Explorer, which determines whether the designated area in the configuration file contains numeric values or tomographic images; (2) The Value Reader, which converts images to text according to ophthalmic measurements; and (3) The Finding Classifier, which classifies pathologic findings from tomographic images included in the report. After assessment of Value Reader accuracy by human experts, all report images were converted and stored in a database. We applied the Value Reader, which achieved 99.67% accuracy, to a total of 433,175 OCT report images acquired in a single tertiary hospital from 07/04/2006 to 08/31/2019. The Finding Classifier provided pathologic findings (e.g., macular edema and subretinal fluid) and disease activity. Patient longitudinal data could be easily reviewed to document changes in measurements over time. The final results were loaded into a common data model (CDM), and the cropped tomographic images were loaded into the Picture Archive Communication System. CONCLUSIONS The newly developed software extracts valuable information from OCT images and may be extended to other types of report image files produced by medical devices. Furthermore, powerful databases such as the CDM may be implemented or augmented by adding the information captured through our program.
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Affiliation(s)
- Yongseok Mun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyunggi-do, 13620, Republic of Korea
| | - Jooyoung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyunggi-do, 13620, Republic of Korea
| | - Kyoung Jin Noh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyunggi-do, 13620, Republic of Korea
| | - Soochahn Lee
- School of Electrical Engineering, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Seok Kim
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyunggi-do, Republic of Korea
| | - Soyoung Yi
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyunggi-do, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyunggi-do, 13620, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyunggi-do, Republic of Korea
| | - Dong Jin Chang
- Department of Ophthalmology, College of medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, 10, 63-ro, Seoul, 07345, Yeongdeungpo-gu, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyunggi-do, 13620, Republic of Korea.
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Raj P, Tejwani S, Sudha D, Muthu Narayanan B, Thangapandi C, Das S, Somasekar J, Mangalapudi S, Kumar D, Pindipappanahalli N, Shetty R, Ghosh A, Kumaramanickavel G, Chaudhuri A, Soumittra N. Ophthatome™: an integrated knowledgebase of ophthalmic diseases for translating vision research into the clinic. BMC Ophthalmol 2020; 20:442. [PMID: 33172432 PMCID: PMC7656766 DOI: 10.1186/s12886-020-01705-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background Medical big data analytics has revolutionized the human healthcare system by introducing processes that facilitate rationale clinical decision making, predictive or prognostic modelling of the disease progression and management, disease surveillance, overall impact on public health and research. Although, the electronic medical records (EMR) system is the digital storehouse of rich medical data of a large patient cohort collected over many years, the data lack sufficient structure to be of clinical value for applying deep learning methods and advanced analytics to improve disease management at an individual patient level or for the discipline in general. Ophthatome™ captures data contained in retrospective electronic medical records between September 2012 and January 2018 to facilitate translational vision research through a knowledgebase of ophthalmic diseases. Methods The electronic medical records data from Narayana Nethralaya ophthalmic hospital recorded in the MS-SQL database was mapped and programmatically transferred to MySQL. The captured data was manually curated to preserve data integrity and accuracy. The data was stored in MySQL database management system for ease of visualization, advanced search functions and other knowledgebase applications. Results Ophthatome™ is a comprehensive and accurate knowledgebase of ophthalmic diseases containing curated clinical, treatment and imaging data of 581,466 ophthalmic subjects from the Indian population, recorded between September 2012 and January 2018. Ophthatome™ provides filters and Boolean searches with operators and modifiers that allow selection of specific cohorts covering 524 distinct ophthalmic disease types and 1800 disease sub-types across 35 different anatomical regions of the eye. The availability of longitudinal data for about 300,000 subjects provides additional opportunity to perform clinical research on disease progression and management including drug responses and management outcomes. The knowledgebase captures ophthalmic diseases in a genetically diverse population providing opportunity to study genetic and environmental factors contributing to or influencing ophthalmic diseases. Conclusion Ophthatome™ will accelerate clinical, genomic, pharmacogenomic and advanced translational research in ophthalmology and vision sciences.
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Affiliation(s)
- Praveen Raj
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | | | - Dandayudhapani Sudha
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | - B Muthu Narayanan
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | - Chandrasekar Thangapandi
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | | | - J Somasekar
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | - Susmithasane Mangalapudi
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | - Durgesh Kumar
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India
| | | | | | | | | | | | - Nagasamy Soumittra
- MedGenome Labs Limited, 3rd Floor, Narayana Nethralaya Building, Narayana Health City, #258/A, Bommasandra, Hosur Road, Bengaluru, Karnataka, 560099, India.
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Marques JP, Carvalho AL, Henriques J, Murta JN, Saraiva J, Silva R. Design, development and deployment of a web-based interoperable registry for inherited retinal dystrophies in Portugal: the IRD-PT. Orphanet J Rare Dis 2020; 15:304. [PMID: 33109251 PMCID: PMC7590677 DOI: 10.1186/s13023-020-01591-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background The development of multicenter patient registries promotes the generation of scientific knowledge by using real-world data. A country-wide, web-based registry for inherited retinal dystrophies (IRDs) empowers patients and community organizations, while supporting formal partnerships research. We aim to describe the design, development and deployment of a country-wide, with investigators and stakeholders in the global aim to develop high-value, high-utility web-based, user-friendly and interoperable registry for IRDs—the IRD-PT.
Results The IRD-PT is a clinical/genetic research registry included in the retina.pt platform (https://www.retina.com.pt), which was developed by the Portuguese Retina Study Group. The retina.pt platform collects data on individuals diagnosed with retinal diseases, from several sites across Portugal, with over 1800 participants and over 30,000 consultations to date. The IRD-PT module interacts with the retina.pt core system which provides a range of basic functions for patient data management, while the IRD-PT module allows data capture for the specific purpose of IRDs. All IRDs are coded accordingly to the International Statistical Classification of Diseases and Related Health Problems (ICD) 9, ICD 10, ICD 11, and Orphanet Rare Disease Ontology (ORPHA codes) to make the IRD-PT interoperable with other IRD registries across the world. Furthermore, the genes are coded according to the Ontology of Genes and Genomes and Online Mendelian Inheritance in Man, whereas signs and symptoms are coded according to the Human Phenotype Ontology. The IRD-PT module pre-launched at Centro Hospitalar e Universitário de Coimbra, the largest reference center for IRDs in Portugal. As of April 1st 2020, finalized data from 537 participants were available for this preliminary analysis. Conclusions In the specific field of rare diseases, the use of registries increases research accessibility for individuals, while providing clinicians/investigators with a coherent data ecosystem necessary to boost research. Appropriate design and implementation of patient registries enables rapid decision making and ongoing data mining, ultimately leading to improved patient outcomes. We have described here the principles behind the design, development and deployment of a web-based, user-friendly and interoperable software tool aimed to generate important knowledge and collecting high-quality data on the epidemiology, genomic landscape and natural history of IRDs in Portugal.
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Affiliation(s)
- João Pedro Marques
- Ophthalmology Unit, Centro de Responsabilidade Integrado em Oftalmologia (CRIO), Centro Hospitalar e Universitário de Coimbra (CHUC), Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. .,University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal. .,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
| | - Ana Luísa Carvalho
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,University Clinic of Medical Genetics, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - José Henriques
- Instituto de Oftalmologia Dr. Gama Pinto (IOGP), Lisbon, Portugal
| | - Joaquim Neto Murta
- Ophthalmology Unit, Centro de Responsabilidade Integrado em Oftalmologia (CRIO), Centro Hospitalar e Universitário de Coimbra (CHUC), Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Jorge Saraiva
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Rufino Silva
- Ophthalmology Unit, Centro de Responsabilidade Integrado em Oftalmologia (CRIO), Centro Hospitalar e Universitário de Coimbra (CHUC), Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
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Abstract
PURPOSE OF REVIEW To summarize how big data and artificial intelligence technologies have evolved, their current state, and next steps to enable future generations of artificial intelligence for ophthalmology. RECENT FINDINGS Big data in health care is ever increasing in volume and variety, enabled by the widespread adoption of electronic health records (EHRs) and standards for health data information exchange, such as Digital Imaging and Communications in Medicine and Fast Healthcare Interoperability Resources. Simultaneously, the development of powerful cloud-based storage and computing architectures supports a fertile environment for big data and artificial intelligence in health care. The high volume and velocity of imaging and structured data in ophthalmology and is one of the reasons why ophthalmology is at the forefront of artificial intelligence research. Still needed are consensus labeling conventions for performing supervised learning on big data, promotion of data sharing and reuse, standards for sharing artificial intelligence model architectures, and access to artificial intelligence models through open application program interfaces (APIs). SUMMARY Future requirements for big data and artificial intelligence include fostering reproducible science, continuing open innovation, and supporting the clinical use of artificial intelligence by promoting standards for data labels, data sharing, artificial intelligence model architecture sharing, and accessible code and APIs.
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Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures. J Ophthalmol 2020; 2020:2421816. [PMID: 32377414 PMCID: PMC7180991 DOI: 10.1155/2020/2421816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 11/24/2022] Open
Abstract
Methods Our center's database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery. Results In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D. Conclusions The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.
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Dubashynskaya NV, Golovkin AS, Kudryavtsev IV, Prikhodko SS, Trulioff AS, Bokatyi AN, Poshina DN, Raik SV, Skorik YA. Mucoadhesive cholesterol-chitosan self-assembled particles for topical ocular delivery of dexamethasone. Int J Biol Macromol 2020; 158:811-818. [PMID: 32371131 DOI: 10.1016/j.ijbiomac.2020.04.251] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/13/2023]
Abstract
The topical application of ophthalmic drugs is a convenient and safe mode of drug administration. However, the bioavailability of topical drugs in the eye is low due to eye barriers and the rapid removal of the drug from the conjunctival surface by the tear fluid. The aim of this study was to obtain dexamethasone-loaded mucoadhesive self-assembled particles based on a conjugate of succinyl cholesterol with chitosan (SC-CS) for potential use as a topical ocular formulation. SC-CS was obtained via a carbodiimide-mediated coupling reaction (degree of substitution DS 1.2-5.8%). SC-CS in the DS range of 1.2-3.0% can self-organize in solution to form positively charged particles (ζ-potential 20-37 mV) of submicron size (hydrodynamic diameter 700-900 nm). The SC-CS particles show good mucoadhesiveness, which decreases with increasing DS. The obtained particles can encapsulate 159-170 μg/mg dexamethasone; they release about 50% of drug in 2 h, and the cumulative drug release reached 95% in 24 h. A cell model confirmed that dexamethasone-loaded SC-CS particles are non-cytotoxic and exhibit a comparable anti-inflammatory activity to that of pure dexamethasone. Testing the osmotic resistance of erythrocytes showed that both dexamethasone-loaded and non-loaded SC-CS particles have greater membrane-stabilizing ability than that of dexamethasone.
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Affiliation(s)
- Natallia V Dubashynskaya
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, St. Petersburg 199004, Russian Federation
| | - Alexey S Golovkin
- Almazov National Medical Research Centre, Akkuratova st. 2, St. Petersburg 197341, Russian Federation
| | - Igor V Kudryavtsev
- Institute of Experimental Medicine, Akademika Pavlova st. 12, St. Petersburg 197376, Russian Federation; Far Eastern Federal University, Sukhanova st. 8, Vladivostok 690090, Russian Federation
| | - Stanislava S Prikhodko
- Almazov National Medical Research Centre, Akkuratova st. 2, St. Petersburg 197341, Russian Federation
| | - Andrey S Trulioff
- Institute of Experimental Medicine, Akademika Pavlova st. 12, St. Petersburg 197376, Russian Federation
| | - Anton N Bokatyi
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, St. Petersburg 199004, Russian Federation
| | - Daria N Poshina
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, St. Petersburg 199004, Russian Federation
| | - Sergei V Raik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, St. Petersburg 199004, Russian Federation; Institute of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Peterhof, St. Petersburg 198504, Russian Federation
| | - Yury A Skorik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, St. Petersburg 199004, Russian Federation; Institute of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Peterhof, St. Petersburg 198504, Russian Federation.
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Bucher F, Mussinghoff P, Kühn T, Stahl A, Böhringer D. [Technical aspects of quality assurance for intravitreal injections (IVI)]. Ophthalmologe 2020; 117:307-312. [PMID: 31912270 DOI: 10.1007/s00347-019-01029-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Successful quality assurance in intravitreal injection (IVI) of medications requires a complex information technology infrastructure. The main challenges are data availability independent of location, standardization of clinical data, integration of extensive and currently non-standardized image documentation from coherence tomography and compliance with data protection regulations. OBJECTIVE In this article the technical implementation and data protection principles are reviewed. MATERIAL AND METHODS Essential aspects in the implementation of quality assurance in the field of IVI are discussed in a systematic approach. RESULTS In the field of network architectures web-based applications supplemented by local virtual private networks (VPN) and/or other software instances have recently replaced the previously commonly used physical data medium exchange. The standardization of the data, e.g. by converting the visual acuity into logMAR, plays an important role in the collection of treatment data. Multiple non-standardized data formats in optical coherence tomography complicate the general quality assurance structure and comparability of data. CONCLUSION International standards will probably facilitate this in the near future. Until then individual solutions have to be found on site.
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Affiliation(s)
- F Bucher
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - P Mussinghoff
- Augenzentrum am St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Kühn
- ContraCare GmbH, Fürth, Nürnberg, Deutschland
| | - A Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - D Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Lockyer J, DiMillo S, Campbell C. An Examination of Self-Reported Assessment Activities Documented by Specialist Physicians for Maintenance of Certification. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:19-26. [PMID: 32149945 DOI: 10.1097/ceh.0000000000000283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Specialists in a Maintenance of Certification program are required to participate in assessment activities, such as chart audit, simulation, knowledge assessment, and multisource feedback. This study examined data from five different specialties to identify variation in participation in assessment activities, examine differences in the learning stimulated by assessment, assess the frequency and type of planned changes, and assess the association between learning, discussion, and planned changes. METHODS E-portfolio data were categorized and analyzed descriptively. Chi-squared tests examined associations. RESULTS A total of 2854 anatomical pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedic surgeons provided data about 6063 assessment activities. Although there were differences in the role that learning played by discipline and assessment type, the most common activities documented across all specialties were self-assessment programs (n = 2122), feedback on teaching (n = 1078), personal practice assessments which the physician did themselves (n = 751), annual reviews (n = 682), and reviews by third parties (n = 661). Learning occurred for 93% of the activities and was associated with change. For 2126 activities, there were planned changes. Activities in which there was a discussion with a peer or supervisor were more likely to result in a change. CONCLUSIONS AND DISCUSSION Although specialists engaged in many types of assessment activities to meet the Maintenance of Certification program requirements, there was variability in how assessment stimulated learning and planned changes. It seems that peer discussion may be an important component in fostering practice change and forming plans for improvement which bears further study.
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Affiliation(s)
- Jocelyn Lockyer
- Dr. Lockyer: Professor, Department of Community Health Sciences, Cumming School of Medicine, Calgary, Canada. Ms. DiMillo: Senior Data and Research Analyst, Health Policy and Advocacy, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada. Dr. Campbell: Principal Senior Advisor, Competency-based CPD and interim Director, Continuing Professional Development, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, and Associate Professor, Department of Medicine, University of Ottawa, Ottawa, Canada
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The Impact on Work Patterns of Implementing the Save Sight Keratoconus Registry in the Hospital Setting. Cornea 2019; 39:451-456. [DOI: 10.1097/ico.0000000000002159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND AND OBJECTIVE Registry studies provide insights into real-life diagnostic and treatment data outside of clinical trials. Registry studies are interesting for quality management and explorative analyses can lead to the identification of possible risk or prognostically relevant factors and generate hypotheses. There are currently relatively few active registry studies in German ophthalmology. The aim of this survey was to collate the different infrastructure and in particular the potential hurdles in the establishment and performance of registry studies in German ophthalmology departments. METHODS An online questionnaire collected data on participation in registry studies in German ophthalmology departments between September and December 2018. The survey was addressed to all hospital management and medical staff involved in registry studies in German ophthalmology. RESULTS Out of 45 participants 18 were head of the department, the remaining 27 were consultants (15), medical specialists (2) and residents (10). According to the department head an average of 2.5 (2.0-3.5) employees per clinic participate in 2.0 (1.7-3.0) registry studies. The amount of reimbursement recommended by the hospital management differed significantly from the amount suggested by the staff (0.0 (0; 75) € (0-100) vs. 100.0 (50.0; 150.0) €; p = 0.0012). The most frequent hurdles to conducting a registry study were bureaucracy and limited human resources. Half of the surveyed centers profited from a separate study center and good clinical practice (GCP) courses for employees involved in studies were mandatory. A quarter of these centers received support from an IT department and/or a statistician. CONCLUSION Registry studies are an important instrument in ophthalmology research and their importance is increasing in Germany. An agreement on national standards would make the establishment of further registry studies easier.
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