David Parke's "Ophthalmic Innovation 2015: A View from the AAO" Presented at OIS@AAO 2015

1. Ophthalmic Innovation 2015
“A View from the AAO”

2. David W. Parke II, MD
CEO
American Academy of Ophthalmology
Ophthalmic Innovation 2015:
a view from the AAO—IRIS®

3. WWW.AAO.ORG
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AMERICAN ACADEMY OF OPHTHALMOLOGY
IRIS® Registry (Intelligent Research In Sight) is the nation’s
first comprehensive eye disease clinical database
• Improve care delivery and
patient outcomes
• Meet requirements of the federal
Physician Quality Reporting System (PQRS)
• Uses HIPAA-compliant methods to upload
data directly from any EHR system
• Advance the science of ophthalmology
• “Real world data” analytics
Introduction to AAO’s IRIS Registry

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Quality Reporting TO Members
 IRIS Registry dashboard approach provides
each participating physician with the ability to
view performance against standards and peers
 Ophthalmologist able to customize query with
risk-adjustment
 Physician able to drill down to patient level
 Physician owns individual data;
AAO owns de-identified, aggregated data

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Integrated with 39 EHRs
• Amazing Charts
• ChartMaker Medical Suite
• Compulink
• Cybax
• DoctorSoft
• eClinicalWorks
• EyeDoc EMR
• Eyefinity ExamWRITER
• EyeMD EMR
• GE Centricity EMR
• Greenway Intergy
• Greenway/Primesuite
• HCIT EHR
• ifa systems EMR
• iMedicWare
• Integrity EMR for Eyes
• IO Practiceware
• KeyChart EMR
• Lytec
• ManagementPlus
• MaximEyes by First Insight
• Mastermind EHR
• MDIntelleSys
• MDoffice
• Medent
• MedEvolve
• Medflow
• Medinformatix EHR
• My Vision Express
• NexTech
• NextGen
• Origin
• Prime Clinical System
• PrognoCIS
• SRS
• TriMed EHR
• VersaSuite
• Vitera EHR
• WebChart by MIE

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AMERICAN ACADEMY OF OPHTHALMOLOGY
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2000
4000
6000
8000
10000
12000
Practices
Physicians
Electronic
Participation in IRIS Registry

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AMERICAN ACADEMY OF OPHTHALMOLOGY
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10
20
30
40
50
60
70
Millions
Timeline
Patient Visits Unique Patients
Unique Patients and Visits

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AMERICAN ACADEMY OF OPHTHALMOLOGY
 Real world
 Big data
• Estimated 49% of U.S. visit volume (2013-present)
 Current data
 Clinical data: outcomes, VA, IOP, free text
 Across all payers
 Across entire profession
• AMD, DR, and glaucoma management by comprehensive
ophthalmologists
Advantages

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AMERICAN ACADEMY OF OPHTHALMOLOGY
# of Eye Conditions by Age
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-5 6-18 19-44 45-64 65-74 75-84 85+
Percent
Age group
6+
5
4
3
2
1
0
Mean = 3.62

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AMERICAN ACADEMY OF OPHTHALMOLOGY
ICD9
code
ICD9 description Count Percent
366.16 Senile nuclear sclerosis 1,757,588 25.83
375.15 Tear film insufficiency, unspecified 1,060,179 15.58
367.4 Presbyopia 1,040,906 15.30
367.1 Myopia 960,602 14.12
379.21 Vitreous degeneration 804,431 11.82
367.0 Hypermetropia 510,550 7.50
367.21 Regular astigmatism 498,302 7.32
366.53 After-cataract, obscuring vision 439,321 6.46
362.51 Nonexudative senile macular
degeneration
410,938 6.04
365.01 Open angle; borderline findings, low
risk
410,691 6.04
Top Ten Conditions

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Mean Visits by Insurance Plan
4.54
4.08
2.60 2.56
2.29 2.30
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Medicare Fee-for-Service Medicare Advantage Private Blue Shield Medicaid Others
Meannumber
Insurance plan

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AMERICAN ACADEMY OF OPHTHALMOLOGY
CPT
Codes
CPT Description Count Percent
67208 Intravitreal injection with a pharmacologic agent 1,069,648 50.46
66984 Cataract surgery with IOL 1-stage 767,931 36.22
66821 After cataract laser surgery 249,319 11.76
66982 Cataract surgery complex 79,882 3.77
68761 Close tear duct opening 63,042 2.97
65855 Laser surgery of eye 62,966 2.97
67820 Revise eyelashes 59,235 2.79
67228 Destruction of extensive or progressive retinopathy,
photocoagulation
47,374 2.23
67210 Destruction of localized lesion of retina,
photocoagulation
44,970 2.12
66761 Revision of iris 44,602 2.34
Top Ten Eye Procedures

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Active ingredient Therapeutic class Patients % of
patients
PREDNISOLONE ACETATE Corticosteroid 195,129 16.76
DEXAMETHASONE Corticosteroid 178,053 15.29
LATANOPROST Prostaglandin 158,620 13.62
MOXIFLOXACIN
HYDROCHLORIDE
Anti-bacterial 152,115 13.06
BRIMONIDINE TARTRATE Alpha adrenergic agonist 148,418 12.75
TOBRAMYCIN Anti-bacterial 144,239 12.39
LOTEPREDNOL ETABONATE Corticosteroid 139,826 12.01
NEPAFENAC Nonsteroidal 129,334 11.11
DIFLUPREDNATE Corticosteroid 114,814 9.86
TIMOLOL Beta blocker 109,733 9.42
Top Ten Eye Medications Prescribed

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Potential Patient Safety Event:
IOL Exchange
 Time period: 2013-2014
 Cataract surgery procedures: 857,738
 IOL exchange:
• 412 occurred within 90 days or .05%
• 1136 occurred within 1 year or .13%

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Infectious Disease Surveillance

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AMERICAN ACADEMY OF OPHTHALMOLOGY
 All AMD 1,321,746
 POAG 1,042,336
 Cataract Surgery 983,522
 Diabetic Retinopathy 697,240
Top Conditions/Procedures
Among Elderly: Jan 2013-Sept 2015

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AMERICAN ACADEMY OF OPHTHALMOLOGY
 334,581 unique patients with POAG
 Average age = 73 years
 Male = 42%; Female = 58%
 Race: White 74%; Black 15%, Hispanic 6%
 Average logMAR Visual Acuity = 0.32
 Average IOP 15.3 mmHg
 Average Cup/Disc = 0.54
Glaucoma Patient Population:
Jan 2013 – June 2014

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Left Eye Visual Acuity

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Left Eye IOP

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AMERICAN ACADEMY OF OPHTHALMOLOGY
 Average Visual Fields/Glaucoma Patient = 3.2
 Average OCTs/Glaucoma Patient = 1.3
 Average ON Scanned Images/Glaucoma
Patient = 2.7
 Total Trabeculoplasties = 73,512
Glaucoma Procedure Utilization
January 2013 – June 2014

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Randomized Registry Trial
 The Randomized Registry Trial-The Next
Disruptive Technology in Clinical Research --Lauer
& D’Agostino, NEJM, Sept 2013
 Time for recruitment and costs were dramatically
less in the randomized registry arm of the trial.
 The incremental cost of the Thrombus Aspiration
in ST-Elevation Myocardial Infarction in
Scandinavia (TASTE) trial was $300,000, or $50 for
each participant who underwent randomization!

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Why This Affects You
 New dataset that is largest comprehensive
specialty registry in the world
 Larger than the complete Medicare dataset
 Will have over 100,000,000 pt visit next yr and
over 30,000,000 unique patients
 Not just claims data but clinical data on
processes, patterns, and outcomes of care
• Risk-adjusted

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AMERICAN ACADEMY OF OPHTHALMOLOGY
Why This Affects You
 Opportunities for industry and the profession
to work together to mine this dataset
 Role in preparation for clinical trials
• Natural history; disease prevalence patterns
• Current ‘real-world’ treatment and outcomes
 Trial design—decrease in enrollment time
 Registry-based trial
 Post-market surveillance