• IRIS Registry Data Analysis

  • The Knights Templar Eye Foundation Pediatric  Ophthalmology Fund 

    The Knights Templar Eye Foundation (KTEF) Inc. Pediatric Ophthalmology Fund was established with a very generous gift from the Knights Templar Eye Foundation to create a primary resource dedicated to data and insights related to pediatric ophthalmology disease.

    The IRIS Registry (Intelligent Research in Sight) is the nation’s first comprehensive eye disease clinical database, started in March 25, 2014 by the American Academy of Ophthalmology.  The primary purpose of the IRIS Registry was to improve care delivery and outcomes for patients receiving eye care in the United States.  Another goal of the IRIS Registry is to provide individual feedback on performance and comparison to benchmarks for the nation’s ophthalmologists.  Another tangible objective of the IRIS Registry was to help ophthalmic practices meet the federal requirements of quality reporting, known as the Merit-based Incentive Payment System (MIPS).  The IRIS Registry was also intended to shorten the time between the generation of important clinical knowledge and implementation of this knowledge by ophthalmologists to improve the care of patients.  Ophthalmologists have said IRIS Registry is the most significant thing the Academy has ever accomplished in terms of improving care.

    However, the IRIS Registry had gaps in the types of ophthalmologists and types of patients participating in the database. Namely, there were fewer numbers of pediatric ophthalmologists and pediatric patients in the IRIS Registry database because pediatric ophthalmologists did not have to participate in the federal quality reporting program (MIPS) so did not need to participate, and a good number of pediatric ophthalmologists are working in academic medical centers, and there were few academic medical centers to start with in the IRIS Registry. 

    The Knights Templar Eye Foundation, Inc. Pediatric Ophthalmology Fund was established in late 2018.  One aim of the Knights Templar Eye Foundation Pediatric Ophthalmology Fund is to aggregate and organize content for a primary pediatric ophthalmology resource.  Another aim of the Knights Templar Eye Foundation Pediatric Ophthalmology Fund is build a site within the IRIS Registry website that is dedicated to pediatric ophthalmology data and insights related to pediatric ophthalmology disease.  A third aim of the Knights Templar Eye Foundation Pediatric Ophthalmology Fund is to provide a way for ophthalmologists to connect in order to ensure best quality of care and access pediatric ophthalmology data, and access past and ongoing pediatric ophthalmology data analyses.

    These are the results of the first year of implementation of the Knights Templar Eye Foundation Pediatric Ophthalmology Fund

    • The number of pediatric patients increased by 325,669 in the IRIS Registry database
    • The number of academic medical centers increased by 21 in the IRIS Registry database
    • The number of pediatric ophthalmology/strabismus quality measures to evaluate the outcomes of pediatric patients increased by 1

    With the support of the Knights Templar Eye Foundation, the Academy is looking to significant improvements and enhancements of the care of pediatric patients in the following ways.  The Knights Templar Eye Foundation Pediatric Ophthalmology Fund will provide pediatric ophthalmologists and patients with the power of “Big Data” to learn and gain insights.  These first three studies (described below) will help pediatric ophthalmologists understand and provide improvements in care of patients with retinopathy of prematurity, choroidal neovascularization and retinal detachments.  The Knights Templar Eye Foundation Pediatric Ophthalmology Fund will become an important force in improving pediatric eye care.  Pediatric ophthalmologists will be able to say that IRIS Registry is the most significant thing the Academy has ever accomplished in terms of improving care for their young and vulnerable patients.

    IRIS Registry Statistics as of April 1, 2020:

    • Contracted:  18,005 physicians from 4,291 practices
    • Contracted for EHR Integration:  15,613 physicians from 3,045 practices
    • Number of Patient Visits:  343.11 million visits, representing 72.70 million patients
    • Pediatric Ophthalmologists Participating in IRIS Registry Database:  427
    • Academic Medical Centers (members of Association of University Professors in Ophthalmology) Participating in IRIS Registry Database:  39
    • Academic Medical Centers, Hospitals and Health Plans Participating in IRIS Registry Database:  49
    • Patients with Retinopathy of Prematurity in IRIS Registry Database:  113,401
    • Pediatric Patients with Cataract Surgery: 5,648
    • Patients with Choroidemia: 1,437 
    • Patients with Harada’s Disease: 1,443 
    • Patients with Achromatopsia: 3,430 
    • Patients with Lebers Optic Neuropathy: 5,514 
    • Patients with Cone-Rod Dystrophy: 28,394
    • Patients with Retinitis Pigmentosa: 102,016
    • Patients with Hereditary Retinoschisis: 165,899

    IRIS Registry Articles related to Pediatric Patients:

    “Strabismus, Strabismus Surgery, and Reoperation Rate in the United States.”  Repka, MX et al.  Ophthalmology 2018; 125:1646-1653.
    https://www.aaojournal.org/article/S0161-6420(18)30484-6/fulltext

    “Endophthalmitis after Cataract Surgery in the United States:  A Report from the Intelligent Research in Sight registry, 2013-2017.” Pershing, S et al.  Ophthalmology 2020; 127:151-158.
     https://www.aaojournal.org/article/S0161-6420(19)31957-8/fulltext

    This fund will support Academy members in private practice who want to use the Academy IRIS Registry database to investigate both rare and common eye diseases affecting children and to uncover optimal, real-world approaches to prevention and treatment.

    2019 Winners of the Knights Templar Eye Foundation, Inc. Pediatric Ophthalmology Fund Award are:

    • Ravi Parikh, M.D., Union Square Eye Care . Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants. The smaller a baby is at birth, the more likely that baby is to develop ROP. It is one of the most common causes of vision loss in childhood. There are typically two treatment options: laser treatment or an injection of medication into the eye. Dr. Parikh will use IRIS Registry data to determine if one treatment is prescribed more than the other, whether one treatment outperforms the other, and whether a baby is more likely to receive one treatment over the other based on demographics.
    • Avni P. Finn, M.D., MBA, Northern California Retina Vitreous Associates. Choroidal neovascularization (CNV) is an abnormal growth of blood vessels at the back of the eye that can cause blindness. Though it can strike adults and children, it’s incredibly rare in children. The causes of CNV are also different in children. Dr. Finn will use IRIS Registry data to better understand why it happens in children, identify the most common treatments used, and which treatments are most effective in children.
    • Peter J. Belin, M.D., VitreoRetinal Surgery, PA. A retinal detachment is an emergency. It happens when a thin layer of tissue at the back of the eye (the retina) pulls away from its normal position. The longer a retinal detachment goes untreated, the greater the risk of permanent vision loss. Most retinal detachments occur in adults, but it can also happen in children. And when it does, it’s more complicated and often requires multiple surgeries for successful treatment. Belin will use the IRIS Registry to identify the best surgical approach to reattach the retina, based on what caused the detachment.

    Three abstracts for the 2020 Academy Annual Meeting were submitted, based on efforts on these projects on pediatric eye disease.

    How it Works

    • Knights Templar Eye Foundation (KTEF) Pediatric Ophthalmology Fund will support four studies.
    • Each study is worth $35,000 of which $5,000 goes to the investigating member and $30,000 goes to the Academy for expenses related to data access and analysis.

    • Awardees will also be supported for travel to the Academy office in San Francisco. During this visit, awardees will learn about the IRIS Registry database, receive an introduction to big data analytics and work closely with Academy staff on the analysis.

    Eligibility Requirements

    To be eligible for the study, you must be:

    • A member of the Academy
    • In private practice
    • A participant in the IRIS Registry or working towards participation

    Application Process 

    Application Overview

    • What is the question or hypothesis you would like to investigate?
    • How do you think big data will help answer your question?
    • What is the clinical significance of your idea?
    • Why are you interested in big data?
    • Do you have experience with big data and/or research?
    • Do you have a specific timeline for analysis?
    • What is your availability for participating in analysis?
    • How does your idea support the Academy’s mission to protect sight and empower lives?
    • Do you know which IRIS Registry data elements you would like to use? (A list of options is available.)
    • Upload your CV or NIH-style bio sketch

    How to Apply

    • Fill out the application and submit before June 30.

    Evaluation Criteria

    • Significance: Does the proposal address an important problem or critical barrier to progress in the field?
    • Candidate: Does the member have high interest and adequate time to devote to the project?
    • Innovation: Is this a unique question for the IRIS Registry?
    • Approach: Is the proposal well thought out? Is the project feasible?

    Timeline

    • The IRIS Registry Analytics Committee will review applications and notify the selected award recipients during summer of 2020.

    For questions or more information about this study, please contact us at irisregistry@aao.org or call 415-561-8592.