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Constance E West, Patricia Cobb, Denise L White; Amblyopia Treatment Outcomes Assessment Using AAO’s IRIS-7 Measure. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3093.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Ophthalmology (AAO) recently announced Center for Medicare and Medicaid Services’ inclusion of “IRIS-7: Amblyopia: Interocular visual acuity” (<a href="http://www.aao.org/assets/d881e07d-238e-4940-ad0a-0ce2ec61157c/635676621663200000/iris-7-amblyopia-interocular-visual-acuity-pdf">www.aao.org/assets/d881e07d-238e-4940-ad0a-0ce2ec61157c/635676621663200000/iris-7-amblyopia-interocular-visual-acuity-pdf</a>) as an outcome measure of effective clinical care. Treatment was defined as “successful” if corrected interocular visual acuity difference (IOD) was <0.23 logMAR 12-18 months after first diagnosis. We report our amblyopia treatment outcomes using IRIS-7.
Electronic health records (EHR) of all new amblyopia patients age 3-7 years in a hospital-based pediatric ophthalmology practice and evaluated during 2013 were reviewed. Multiple logistic regression analysis was used to assess factors affecting successful and unsuccessful treatment.
Of the 477 new patients diagnosed with amblyopia, 199 met IRIS-7 inclusion criteria. Of these, 91 (46%) had IODexit<0.23 less than 18 months after initial diagnosis, including 65 with IODexit<0.23 at 12-18 months (IRIS-7-defined “Performance Met”). IODentry, number of attended visits, atropine prescription, and average days between visits correlated with successful outcome (backward elimination technique, ROC=0.83). Age, race, ethnicity, payor, and number of missed visits were not associated with successful treatment outcome. The EHR did not record an easily extractible assessment of patching hours recommended or compliance with treatment, so dosing or compliance effect could not be assessed.
In this first-reported application of IRIS-7, our outcomes leave room for improvement; less than half of our patients were successfully treated for amblyopia using IRIS-7 criteria. Further subgroup analysis, including cycloplegic refraction, physician practice patters, comparison with results of other centers, and focused, prospective interventions may help to uncover factors that are amenable to intervention when managing this patient population.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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