The Epidemiology and Risk Factors for the Progression of Sympathetic Ophthalmia in the United States: An IRIS Registry Analysis

Abstract

To investigate the demographic and clinical characteristics of patients with sympathetic ophthalmia (SO) and define the risk factors for its incidence following trauma and ophthalmic procedures. Retrospective cohort study. Patients in the American Academy of Ophthalmology's (Academy) IRIS® Registry (Intelligent Research in Sight) who were (n=1,523) or were not diagnosed with SO following a documented procedure or trauma between January 1st, 2013, and December 31st, 2019. Multiple demographic and clinical factors were collected, descriptive statistics and prevalence were calculated, and multivariate linear regression models were fit to the data. Prevalence of SO, demographic and clinical characteristics, and beta coefficient (β) estimates of demographic and clinical characteristics impacting time to SO onset after procedure ('Procedure Only' cohort) or trauma ('Trauma cohort'). Out of 65,348,409 distinct IRIS Registry patients, 1,523 (0.0023%) were diagnosed with SO between 2013-2019, and also had a documented preceding trauma or procedure. Of these, 927 (60.87%) were females, 1,336 (87.72%) belonged to the 'Procedure Only' cohort, and 187 (12.28%) belonged to the 'Trauma' cohort. The prevalence of SO after trauma was 0.0207% while after procedures it was 0.0124%. The highest risk of procedure-related SO was seen in patients with history of "other anterior segment" (0.122%) followed by glaucoma (0.066%) procedures whereas the lowest prevalence was noted with cataract surgeries (0.011%). The average time to onset of SO across both cohorts combined was 527.44 (±715.60) days, with statistically significant differences between the two cohorts (p<0.001). On average, the time to onset from inciting event to SO was shorter with increasing age, by 9.02 (95% CI: -11.96, -6.08) days for every one-year increase. SO following trauma and ophthalmic procedure is potentially rarer than previously reported, as measured in this large ophthalmic medical record database. Female sex may be a risk factor for SO. Older age may be a risk factor for quicker onset. These findings can guide clinical decision-making and management.