Eye Care Visits Research Articles

Relationship between Neighborhood-Level Social Risk Factor Measures and Presenting Glaucoma Severity Utilizing Multilevel Modeling

PurposeThe neighborhood and built environment social determinant of health domain has several social risk factors (SRF) that are modifiable through policy efforts. We investigated the impact of neighborhood-level SRFs on presenting glaucoma severity at a tertiary eye care center. DesignA cross-sectional study from August 2012 to May 2022 in the University of Michigan (UM) electronic health record (EHR). ParticipantsPatients with a diagnosis of any open angle glaucoma with ≥1 eye care visit at the UM Kellogg Eye Center and ≥1 reliable visual field. MethodsParticipants who met inclusion criteria were identified by ICD9/10 codes (365.x/H40.x). Data extracted from the EHR included patient demographics, address, presenting mean deviation (MD), and visual field reliability. Addresses were mapped to SRF measures at the census tract, block group, and county levels. Multilevel linear regression models were used to estimate the fixed effects of each SRF on MD, after adjusting for patient-level demographic factors and a random effect for neighborhood. Interactions between each SRF measure with patient-level race and Medicaid status were tested for an additive effect on MD. Main Outcome MeasuresThe main outcome measure was the effect of SRF on presenting MD. ResultsIn total, 4428 patients were included in the analysis who were, on average, 70.3 years old (standard deviation=11.9), 52.6% self-identified as female, 75.8% self-identified as White, and 8.9% had Medicaid. The median value of presenting MD was -4.94 dB (interquartile range=-11.45 to -2.07 dB). Neighborhood differences accounted for 4.4% of the variability in presenting MD. Neighborhood-level measures, including worse area deprivation (estimate, β=-0.31 per 1-unit increase; p<0.001), increased segregation (β=-0.92 per 0.1-unit increase in Theil’s H index; p<0.001), and increased neighborhood Medicaid (β=-0.68; p<0.001) were associated with worse presenting MD. Significant interaction effects with race and Medicaid status were found in several neighborhood-level SRF measures. ConclusionsAlthough patients’ neighborhood SRF measures accounted for a minority of the variability in presenting MD, most neighborhood-level SRFs are modifiable and were associated with clinically meaningful differences in presenting MD. Policies that aim to reduce neighborhood inequities to address allocation of resources could have lasting impacts on vision outcomes.

Disparities in glaucoma and macular degeneration healthcare utilization among persons living with dementia in the United States.

Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia. Optum's de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes. POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75-0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63-0.68) and OCT (RR 0.67, 95% CI: 0.64-0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83-0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70-0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58-0.69) than those without dementia. POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.

Practice Patterns and Sociodemographic Disparities in the Clinical Care of Anatomical Narrow Angles in the United States

PurposeTo assess treatment and visit patterns among patients with newly diagnosed anatomical narrow angle (ANA) and identify sociodemographic factors associated with disparities in care. DesignRetrospective practice pattern evaluation study. Methods263,422 patients diagnosed with ANA between 2007 to 2019 were identified in the Optum Clinformatics® Data Mart. Inclusion was limited to newly diagnosed ANA, defined as: 1) continuous enrollment during a 2-year lookback period and 1-year study period from first diagnosis, (2) diagnosis by an ophthalmologist or optometrist, (3) no history of pseudophakia, ANA treatments, or prior PACG diagnosis. Outcome measures were treatment with laser peripheral iridotomy (LPI), cataract surgery, or IOP-lowering medications and number of eyecare visits. Logistic and Poisson regression were performed to assess factors associated with treatment and eyecare visits, respectively. ResultsAmong 52,405 eligible cases, 27.7% received LPI, 13.9% received drops, and 15.1% received cataract surgery. Odds of LPI was higher in Asians and Hispanics (OR≥1.16, p<0.001). Non-whites had higher odds of drops (OR≥1.19, p<0.001), but Hispanics had lower odds of cataract surgery (OR=0.79, p<0.001). The mean number of eyecare visits was 2.6±2.1 visits including the day of diagnosis. Older age and treatment were associated with higher rates of eye care visits (RR>1.15, p<0.001). ConclusionMore than a quarter of patients with newly diagnosed ANA receive treatment with LPI. Racial minorities are more likely to receive ANA-specific treatments but less likely to receive cataract surgery. These differences may reflect racial differences in disease severity and the need for clearer practice guidelines in ANA care.

The Influence of Parents' Background and Their Perception on the Progression of Myopia in Children.

To study the influence of parents' educational backgrounds and understanding on the progress of myopia in their offspring. Spherical equivalent refraction (SE) of the children (aged 6-14) in China was assessed with cycloplegic autorefraction in a two-year longitudinal study. The parents' background information and myopia-related cognition were collected by questionnaires. The offspring of parents with lower education and more myopic SE had higher myopic progression (mean = -1.42 ± 1.06) than the children of other groups (P < 0.05). The parents' understanding of the proper outdoor activity time, sleep duration, reading distance, and indoor illumination for children was not significantly correlated with the progression of myopia in their offspring. The parent's preference for eye care visit frequency had a significant correlation with the myopia development of their children (r = 0.076, P=0.001∗). The mean SE progression was -0.84 ± 1.37 and -0.58 ± 1.29 in the children whose parents considered that extracurricular classes would negatively affect myopia development progression and the children whose parents believed it would not, respectively (P=0.026∗). Most parents misunderstand the influence of insufficient outdoor sports time and extracurricular classes, which require extra near-vision work. Besides, for parents with low educational background and more myopic SE, their offspring had higher myopia progression and may be the key group for myopia control. Finally, parents may obtain life advice and knowledge related to preventing myopia after their children become myopic. It may be of positive significance if this process could take place before myopia onset.

Impact of Dry Eye Diseases in Daily Life: A Review Study in a Tertiary Care Hospital in Dhaka

Background: Now a day, dry eye disease (DED) is one of most common ocular disease and reason for primary eye care visit worldwide. Dry eye disease should be considered as an important public health problem deserving increased attention. As a rising public health concern, dry eye disease causing ocular distress, fatigue and visual disturbance that obstructs with quality of life, including aspects of physical, social, psychological functioning, daily activities as well as workplace productivity. Objective: The objective of this study was to assess the effect of dry eye disease on daily life and activities of the patients with dry eye diseases. Materials and Methods: This was a prospective observational study, conducted at the National Institute of Ophthalmology and Hospital (NIO &amp; H), Dhaka, Bangladesh during the period from January 2003 to December 2004. In total 43 patients of dry eye diseases of several ages with proper documents were finalized as the study population. The study was approved by the ethical committee of the mentioned hospital. The proper written consents were taken from all the participants before starting the main part of intervention. Data were collected by predesigned questioner and analyzed by SPSS program. Results: We found the highest 30.23% (n=13) participants felt difficulties in driving at night. Besides this 27.91%(n=12), 25.58% (n=11), 20.93% (n=9), 18.60% (n=8), 11.63%(n=5), 9.30%(n=4), 6.98%(n=3), 4.65%(n=2), 4.65% (n=2), participants felt difficulties in reading small print out, reading newspaper, fill-up printed forms, viewing road signs, watching television, navigating stairs, cooking, playing chess/cards and driving at daytime respectively. In this study we found, among all the participants 3(6.98%) felt major difficulties, 8(18.60%) felt minor difficulties and 32(74.42%) felt no difficulty in reading newspaper. Conclusion: In this study, we found that symptomatic dry eye was significantly associated with a reduced ability .........

Reduced visits to pediatric eye care among socioeconomically disadvantaged patients during the COVID-19 pandemic

We hypothesized that children with low socioeconomic status (SES) had disproportionately fewer eye care visits during the early COVID-19 pandemic and that these children would be less likely to use synchronous provider-to-patient telemedicine eye care visits. This study investigated changes in patient demographics at a large, academic pediatric eye center before and after the pandemic. A retrospective review of all visits from March 18, 2019, to May 31, 2019 (pre-COVID period) and of the same date range in 2020 (COVID period) was performed. Patient addresses were used to calculate the Area Deprivation Index (ADI), a validated measure of a neighborhood’s SES. Patients who identified as non-White, and those requiring an interpreter had relatively fewer visits during the COVID period compared to the pre-COVID period. In addition, relatively fewer telemedicine visits were performed with patients who lived in a neighborhood classified as at or above the 50th ADI percentile (more disadvantaged).

Potentially Missed Opportunities in Prevention of Acute Angle-Closure Crisis

ImportanceIf an anatomic narrow angle is not appropriately diagnosed and treated, it can result in acute angle-closure crisis (AACC) and lead to substantial vision loss.ObjectiveTo identify patients who presented with AACC and assess for factors that may have been associated with risk of developing it.Design, Setting, and ParticipantsThis population-based retrospective cohort study conducted from January 1, 2001, to December 31, 2015, included a 20% nationwide sample of 1179 Medicare beneficiaries. Patients aged 40 years or older with AACC were identified with billing codes. A 2-year lookback period from the date of initial presentation of AACC was used to identify patients who had at least 1 eye care visit, received a diagnosis of open-angle glaucoma (OAG) or suspected OAG, or received at least 1 medication associated with risk of AACC. Of the patients who had at least 1 eye care visit, those who underwent gonioscopy, received a diagnosis of an anatomic narrow angle before developing AACC, or both were identified.Main Outcomes and MeasuresProportions of patients who had at least 1 eye care visit, had OAG or suspected OAG, received at least 1 medication associated with risk of AACC, underwent gonioscopy, or received a diagnosis of an anatomic narrow angle before development of AACC.ResultsA total of 1179 patients had a confirmed diagnosis of AACC. The mean (SD) age of patients with AACC was 66.7 (11.8) years (range, 40-96 years), 766 were women (65.0%), 57 were Asian (4.8%), 109 were Black (9.2%), 126 were Latino (10.7%), 791 were White (67.1%), and 96 were other race and ethnicity (8.1%). Of these patients, only 796 (67.5%) consulted an optometrist or ophthalmologist at least once during the 2-year lookback period. A total of 464 individuals (39.4%) had OAG or suspected OAG, and 414 (35.1%) had received at least 1 medication associated with increased risk of AACC before developing it. Of the 796 patients who consulted an optometrist or ophthalmologist in the lookback period, less than one-third underwent gonioscopy in the 2 years before developing AACC (n = 264 [33.2%]), and less than one-half of all patients undergoing gonioscopy received a diagnosis of an anatomic narrow angle (n = 113 [42.8%]). Most patients underwent gonioscopy in the 1 to 4 weeks preceding the AACC.Conclusions and RelevanceIn this group of Medicare patients, there appear to have been multiple opportunities for interventions that may have averted AACC. Interventions aimed at addressing risk factors associated with AACC and improving performance of gonioscopy might be associated with reduced risk for ocular morbidity.

Patient Satisfaction in the Era of COVID-19: Virtual Visit versus In-person Visit Satisfaction.

Teleophthalmology became widely used during the coronavirus 2019 pandemic; however, the quality of this care remains to be understood. This study aimed to compare patient satisfaction levels from virtual and in-person visits based on post-visit surveys, as well as investigate demographic characteristics that may predict patient satisfaction with virtual visits. Virtual (n = 2943) and in-person (n = 56,175) visits from March 19, 2020, to July 31, 2020, were identified using the electronic health record system. For in-person visits, a random subset of 3000 visits was acquired using a random number generator. Of these, 2266 virtual and 2590 in-person visits met the inclusion criteria. Patients who completed the Telemedicine for Medical Practice Survey and Medical Practice Survey were analyzed in this report. Nonparametric Mann-Whitney test was used to compare scores between groups. Two hundred eleven virtual patients (9.31%; 82 phone, 115 video, 14 hybrid) and 307 in-person patients (11.85%) completed the Telemedicine for Medical Practice Survey and Medical Practice Survey, respectively. Satisfaction scores were similar and high in both groups-virtual visit satisfaction scores averaged 4.82, whereas in-person visit satisfaction averaged 4.85 (P = .80, θ = 0.501 [0.493 to 0.509]). Only one question yielded significantly different satisfaction scores, and no demographic variables were significant predictors of satisfaction scores. Patient satisfaction is comparable between virtual and in-person visits, validating the continued usage of telemedicine for eye care visits.

Utilization of emergency ophthalmology services in Taiwan: a nationwide population study

The aim of this study was to conduct a nationwide survey of the use of emergency ophthalmology services using a sub-dataset of one million beneficiaries sampled from Taiwan’s National Health Insurance Research Database (NHIRD) for the years 2008 through 2012. By analyzing this population dataset, the study illustrates the disease landscape of emergency eye care services. The five-year, one-million-person NHIRD sub-dataset for 2008 through 2012 was used to explore emergency visits and ophthalmology specialty visits and to analyze the associated demographics and diagnosis codes based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Diagnoses were categorized into three groups: urgent, non-urgent, and intermediate. A total of 2454 emergency eye care visits were identified. The mean age of the patients who made these visits was 34.6 years old, and their sex ratio was 1.36 men to women. The percentages of urgent, non-urgent, and intermediate eye care visits in this study were 48.2%, 30.9%, and 20.9%, respectively. The leading diagnoses in the urgent category were corneal abrasions, foreign bodies in the eyes, eye burns, and blunt eye injuries. The leading diagnoses for the non-urgent visits were conjunctivitis, subconjunctival hemorrhages, trichiasis, and dry eye disease. Those for the intermediate category were superficial punctate keratitis, corneal opacity and degeneration, and lid, orbital, and lacrimal drainage infections. The urgent visit category accounted for nearly half of all the visits identified in this study. Compared to outpatient department visitors, the emergency ophthalmology service patients were younger and more predominantly male. These results were consistent with those of previous reports. Low copays have made emergency ophthalmology services highly accessible in Taiwan. However, future policies can be designed to more effectively allocate resources to urgent cases.

Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia

To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries. Retrospective, claims-based analysis. A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31,2015. Dementia was identified from diagnosis codes documented in a beneficiary's first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities. Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters). A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69-0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55-0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62-0.63) and less likely to receive a cataract diagnosis (18% vs. 82%). US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care thanthose without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value topatients with dementia, and implement measures to improve access to appropriate eye care.

Attitude and practice toward diabetic retinopathy among omani population

Background: Poor patient compliances toward diabetic retinopathy (DR)-related care are associated with the barriers at a personal, interpersonal, societal, organizational, or a policy level. The personal factors contributing to noncompliance are linked with their negative attitude toward the disease management. Materials and Methods: It is a cross-sectional, questionnaire-based, prospective study. The study involved 232 participants from different provinces in Oman and with different socioeconomic and educational levels through a convenient sampling method. Participants' attitude toward DR was assessed using the responses for the provided statement related to the condition through a self-designed and validated questionnaire. Statistical Analysis Used: The Shapiro–Wilk normality test was applied and observed the nonnormal distribution of the attitude scores. Hence, the nonparametric Mann–Whitney U test was applied to compare the percentage score with the independent groups of the study. Practicing pattern of the participants having a personal or family history of diabetes mellitus was evaluated using descriptive statistics. Results: Two hundred and thirty-two participants having mean age of 31.12 (standard deviation [SD] = 12.02) years responded to the questionnaire, of which 39.22% were male and 60.78% were female. The mean percentage attitude score was 83.09 (SD = 12.90, 24.44–100). About 82% of the study participants had a very positive attitude. Very few (12.73%) were noncompliant toward routine ocular examination. 82% of the study participants had a positive attitude and 87.27% were positively following eye care visits. Conclusions: Majority of the study participants have positive attitude toward the management of DR and practice for follow-up eye care visits as recommended by their eye care practitioners. DR-related health promotional activities within the population having lower educational status can support in improving their compliance.

TESTOSTERONE SUPPLEMENTATION AND RETINAL VASCULAR DISEASE.

To determine whether testosterone supplementation is associated with retinal artery occlusion (RAO) or retinal vein occlusion (RVO). Retrospective matched cohort study using data from a large national U.S. insurance database. The testosterone cohort consisted of all male patients who filled a prescription for testosterone from 2000 to 2013. Five controls were matched on age (±3 years), sex, race, and similar time in plan (±3 months) for every exposed patient. Exclusion occurred for <2 years in the plan, <1 eye care visit, medications known to affect androgen levels, and systemic diseases associated with occlusions or increased testosterone. Cox proportional hazard regression assessed the hazard of a new diagnosis of RAO or RVO while controlling for age, race, diabetes mellitus, and hypertension. A total of 35,784 incident testosterone users were compared with 178,860 matched controls. Ninety-three (0.3%) RAOs and 50 (0.1%) RVOs were found in the testosterone cohort and contrasted with 316 (0.2%) RAOs and 232 (0.1%) RVOs in the control group. After multivariate analysis, testosterone supplementation significantly increased the hazard of RAO (hazard ratio: 1.43, 95% confidence interval: 1.12-1.81, P = 0.004), but not of RVO (hazard ratio: 1.03, 95% confidence interval: 0.74-1.42, P = 0.86). Although the incidence of RAO and RVO is low in users of testosterone, supplementation therapy is associated with an increased hazard of RAO, but apparently not of RVO.

Self-reported Use of Eye Care Among Adult Chinese Americans: The Chinese American Eye Study

To identify the prevalence and determinants of self-reported eye care use among Chinese Americans. Population-based, cross-sectional study. A total of 4582 Chinese Americans 50 years and older residing in Monterey Park, California. Multivariable logistic regression analyses based on Andersen's Behavioral Model of Health Services Use were conducted to identify predisposing, enabling, and need variables associated with self-reported eye careuse. Prevalence of self-reported use assessed as eye care visit in the past 12 months, dilated eye examination in the past 12 months, and ever having had a dilated examination, and odds ratios for factors associated with these measures. Overall, 36% of participants reported an eye care visit and 21% reported a dilated examination in the past 12months. Forty-eight percent reported ever having had a dilated eye examination. Older age, female sex, preference for English, more education, health and vision insurance, a usual place for health care, currently driving, a greater number of comorbidities, and lower vision-specific quality-of-life (NEI VFQ-25) scores were associated with higher odds of reporting use of eye care. Use of eye care among Chinese Americans was found to be as low as what is reported for African Americans and Hispanics, and lower than what is reported for whites. Multiple modifiable factors are associated with use of eye care among the rapidly growing Chinese American population. Culturally sensitive interventions targeting these factors should be a priority. Further research is needed to investigate how findings from this group of Chinese Americans reflect other Asian Americans that are different in language and ethnicity.

Association Between County-Level Characteristics and Eye Care Use by US Adults in 22 States After Accounting for Individual-Level Characteristics Using a Conceptual Framework.

Individual-level characteristics are associated with eye care use. The influence of contextual factors on vision and eye health, as well as health behavior, is unknown. To examine the association between county-level characteristics and eye care use after accounting for individual-level characteristics using a conceptual framework. This investigation was a cross-sectional study of respondents 40 years and older participating in the Behavioral Risk Factor Surveillance System surveys between 2006 and 2010 from 22 states that used the Visual Impairment and Access to Eye Care module. Multilevel regressions were used to examine the association between county-level characteristics and eye care use after adjusting for individual-level characteristics (age, sex, race/ethnicity, educational attainment, annual household income, employment status, health care insurance coverage, eye care insurance coverage, personal established physician, poor vision or eye health, and diabetes status). Data analysis was performed from March 23, 2014, to June 7, 2016. Eye care visit and receipt of a dilated eye examination in the past year. Among 117 295 respondents who resided in 828 counties, individual-level data were obtained from the Behavioral Risk Factor Surveillance System surveys. All county-level variables were aggregated at the county level from the Behavioral Risk Factor Surveillance System surveys except for a high geographic density of eye care professionals, which was obtained from the 2010 Area Health Resource File. After controlling for individual-level characteristics, the odds of reporting an eye care visit in the past year were significantly higher among people living in counties with high percentages of black individuals (adjusted odds ratio [aOR], 1.12; 95% CI, 1.01-1.24; P = .04) or low-income households (aOR, 1.12; 95% CI, 1.00-1.25; P = .045) or with a high density of eye care professionals (aOR, 1.18; 95% CI, 1.07-1.29; P < .001) than among those living in counties with the lowest tertile of each county-level characteristic. The odds of reporting receipt of a dilated eye examination in the past year were also higher among people living in counties with the highest percentages of black individuals (aOR, 1.20; 95% CI, 1.07-1.34; P = .002) or low-income households (aOR, 1.17; 95% CI, 1.04-1.32; P = .01). However, the odds of reported receipt of a dilated eye examination in the past year were lower in counties with the highest percentages of people with poor vision and eye health compared with counties with lower percentages (aOR, 0.85; 95% CI, 0.77-0.94; P = .002). Contextual factors, measured at the county level, were associated with eye care use independent of individual-level characteristics. The findings suggest that, while individual characteristics influence health care use, it is also important to address contextual factors to improve eye care use and ultimately vision health.

Pattern of Ophthalmic Services Utilization in the Asawase Constituency of Ghana.

Purpose: Our objective was to determine how ophthalmic services were utilized by the people of the Asawaseconstituency in the Ashanti region of Ghana Methods: One thousand six hundred and thirty (1630)Asawase citizens were sampledthrough a populationbased, cross-sectional study. Study respondents underwent comprehensive eye examination. An interview session was used to source information on their demographics, socioeconomic status, medical and ocular history and recent eye care visits. Results: There was 84% participatory rate; 1369 respondents participated in the study.Out of this number,31 % had never visited an ophthalmologist or optometrist and the 50% of them who had ever visitedan eye care clinician hadtheir last eye exams over 4 years ago.The study revealed that youngerparticipants,women and the lesseducated were more likely to have not accessed any form of eye care.Majority (31%) of the participants had never sought for the services of an ophthalmic specialist. Conclusion: The findings of the study suggest that further investigation into the causes of the pooruse of the available ophthalmic serviceswill help understand and improve eye care situation in this particular population.

Association Between Statin Use and Open-angle Glaucoma in Hyperlipidemia Patients: A Taiwanese Population-based Case-control Study.

The aim of the study was to investigate the association between statin use and open-angle glaucoma (OAG) risk in hyperlipidemia patients.We used the research database of the Taiwan National Health Insurance program to conduct a population-based case-control study. A total of 1276 patients with newly diagnosed OAG were identified from 2004 to 2011. Controls comprised of 12,760 patients without glaucoma and were frequency-matched for age, sex, history of diabetes mellitus, and year of hyperlipidemia diagnosis at a 1:10 ratio. Accumulated defined daily doses (DDDs) of statins prescribed during follow-up were calculated. Average statin use was calculated as the sum of DDDs divided by the duration from the initial statin prescription date to the index date (per year), and was subdivided into 3 levels: <30, 30 to 119, and ≥120 DDDs. Comorbidity, including hypertension, depression, and the Charlson comorbidity index, the frequency of eye care visits, and the use of nonstatin cholesterol-lowering drugs, were all considered as confounding factors.For the group with statin use, the adjusted odds ratio of OAG was 1.02 (95% confidence interval 0.90–1.15) when compared with the group without statin use. Subanalysis showed that a high dosage of statin use (≥120 DDD/y) resulted in a1.24-fold increased risk of OAG (odds ratio 1.24, 95% confidence interval 1.03–1.49). The incidence of OAG was increased with the increase of the dosage of statin use (P for trend = 0.0458).Clinicians should be cautious of hyperlipidemia patients with a high dosage of statin use because it might be associated with an increased risk of OAG. Ophthalmologist consultation is necessary for this high-risk group.

Patterns of Glaucoma Medication Adherence over Four Years of Follow-Up

To assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up. Retrospective, longitudinal cohort analysis. Beneficiaries aged ≥40 years who were enrolled in a United States (US)-managed care plan for ≥7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma. For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses. Patterns of glaucoma medication adherence. Of the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (β = -0.06/dollar, P = 0.03). For most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.

Regular examinations for toxic maculopathy in long-term chloroquine or hydroxychloroquine users.

According to evidence-based, expert recommendations, long-term users of chloroquine or hydroxychloroquine sulfate should undergo regular visits to eye care providers and diagnostic testing to check for maculopathy. To determine whether patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) taking chloroquine or hydroxychloroquine are regularly visiting eye care providers and being screened for maculopathy. Patients with RA or SLE who were continuously enrolled in a particular managed care network for at least 5 years between January 1, 2001, and December 31, 2011, were studied. Patients' amount of chloroquine or hydroxychloroquine use in the 5 years since the initial RA or SLE diagnosis was calculated, along with their number of eye care visits and diagnostic tests for maculopathy. Those at high risk for maculopathy were identified. Logistic regression was performed to assess potential factors associated with regular eye care visits (annual visits in ≥3 of 5 years) among chloroquine or hydroxychloroquine users, including those at highest risk for maculopathy. Among chloroquine or hydroxychloroquine users and those at high risk for toxic maculopathy, the proportions with regular eye care visits and diagnostic testing, as well as the likelihood of regular eye care visits. Among 18 051 beneficiaries with RA or SLE, 6339 (35.1%) had at least 1 record of chloroquine or hydroxychloroquine use, and 1409 (7.8%) had used chloroquine or hydroxychloroquine for at least 4 years. Among those at high risk for maculopathy, 27.9% lacked regular eye care visits, 6.1% had no visits to eye care providers, and 34.5% had no diagnostic testing for maculopathy during the 5-year period. Among high-risk patients, each additional month of chloroquine or hydroxychloroquine use was associated with a 2.0% increased likelihood of regular eye care (adjusted odds ratio, 1.02; 95% CI, 1.01-1.03). High-risk patients whose SLE or RA was managed by rheumatologists had a 77.4% increased likelihood of regular eye care (adjusted odds ratio, 1.77; 95% CI, 1.27-2.47) relative to other patients. In this insured population, many patients at high risk for maculopathy associated with the use of chloroquine or hydroxychloroquine are not undergoing routine monitoring for this serious adverse effect. Future studies should explore factors contributing to suboptimal adherence to expert guidelines and the potential effect on patients' vision-related outcomes.

PHS24 - Comparative Effectiveness And Costs Of Strategies To Improve Follow-Up For Diabetic Eye Care Visits

PHS24 - Comparative Effectiveness And Costs Of Strategies To Improve Follow-Up For Diabetic Eye Care Visits

Identification of Persons With Incident Ocular Diseases Using Health Care Claims Databases

To assess the extent to which incidence rates calculated for common ocular diseases by using claims data may be overestimated according to the length of the disease-free look-back period used in the analysis. Retrospective longitudinal cohort analysis. Billing records of 2457 persons continuously enrolled for 11 years in a managed-care network were searched for International Classification of Diseases (ICD-9-CM) diagnoses of cataract, open-angle glaucoma (OAG), nonexudative age-related macular degeneration (ARMD), and nonproliferative diabetic retinopathy (NPDR) at eye-care visits in the first half of 2001, the second half of 2010, and 2011. For each condition, incidence rates calculated by using "look-back" periods ranging from 0.5-9 years were compared with best estimates from a gold-standard period of 9.5 years. With a 1-year disease-free look-back period, incidence was overestimated by 260% for cataract, 135% for OAG, 209% for ARMD, and 300% for NPDR. Expanding the disease-free look-back period to 3 years resulted in a reduction of incidence overestimation to 40% for cataract, 14% for OAG, 45% for ARMD, and 100% for NPDR. A 5-year look-back period yielded incidence rates that were overestimated by <30% for all 4 conditions. In our claims-data analysis of 4 common ocular conditions, a disease-free interval ≤1 year insufficiently distinguished newly diagnosed from pre-existing disease, resulting in grossly overestimated incidence rates. Using look-back periods of 3-5 years, depending on thespecific diagnosis, yielded considerably more accurate estimates of disease incidence.