• Cataract/Anterior Segment, Comprehensive Ophthalmology

    “Big data” is typically defined as a dataset of such large volume, variety and velocity that it does not fit in an Excel spreadsheet. The Academy’s Intelligent Research in Sight (IRIS®) Registry is one such big data repository, which, as of December 31, 2014, included 6.5 million unique patients with 17.2 million patient encounters.

    As the nation's first comprehensive eye disease clinical registry, the IRIS Registry allows ophthalmologists to meet quality reporting requirements of federal programs, as well as track their own performance and compare their patients' outcomes with national benchmarks.

    During the 2015 Jackson Memorial Lecture, Dr. Anne Coleman described how big data will play a critical role in evaluating standards and quality of care across the practice of ophthalmology.

    As an example, Dr. Coleman showed how data collected in the IRIS Registry are already providing insight into rare events such as endophthalmitis after cataract surgery.

    She evaluated a 5% sample of Medicare claims data for 4 successive years (2010–2013; 216,703 individuals) and data from the IRIS Registry for 2 years (2013–2014; 511,182 individuals), which includes clinical information not available in the Medicare data set such as visual acuity.

    The endophthalmitis rates were 0.14% and 0.08% based on the Medicare and IRIS Registry data, respectively.

    Dr. Coleman offers some explanations for this discrepancy.

    First, the IRIS Registry patients were younger, and second, some patients might have undergone cataract surgery by an IRIS Registry participant and were followed by a nonparticipant. Third, the Medicare claims data set doesn’t indicate laterality, which means the endophthalmitis isn’t necessarily in the same eye that had surgery.

    Big data can also help identify additional areas for quality improvement, such as the 18.3% of eyes in the IRIS Registry having 1-month postoperative VA worse than 20/40. The data set also showed a higher rate of endophthalmitis in eyes that underwent combined cataract surgery and anterior vitrectomy (P=0.051), even though only 0.08% of eyes had this combined procedure.