Open Globe Repairs in the United States 2014-2018: Incidence, risk factors and visual outcomes - An IRIS® Registry (Intelligent Research in Sight) Analysis

Abstract

Purpose : Open globe injuries (OGI) are an important cause of visual impairment worldwide. This retrospective cohort analysis evaluates incidence and risk factors associated with open globe repairs (OGR) and visual acuity (VA) outcomes after surgery in the American Academy of Ophthalmology IRIS Registry.

Methods : Patients with OGR were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, 65265) from 2014 to 2018 in the IRIS Registry. Annual and 5-year incidence rates per 100,000 persons were calculated. Factors associated with OGR and VA <20/40 and VA <20/200 at final follow up (3 to 12 months post OGR) were evaluated using multivariable logistic regression models adjusting for sex, race, ethnicity, US region, concurrent and subsequent surgeries, and baseline VA. Statistical analyses were performed in R.

Results : 15,316 OGR’s were identified during the study period; 5-year incidence was 30.1/100,000. Annual incidence ranged from 10.9 to 12.7/100,000. OGR was positively associated with older v younger ages <21 yrs, e.g. > 80 yrs (OR, 4.9 [CI: 4.1-6.0]); male v female (OR, 3.1 [CI: 2.7-3.6]); Black v White race (OR, 1.7 [CI, 1.5-2.1]); Hispanic v Non Hispanic ethnicity (OR, 1.4 [CI, 1.2-1.7]); living in the South (OR, 1.40 [CI, 1.33-1.47]) and West (OR- 1.29 [CI, 1.21-1.36]) (v Midwest) regions and inversely associated with Asian v White race (OR- 0.5 [CI, 0.3-0.8]). Vision impairment final follow up was associated with VA <20/200 at presentation (20/200 v better than 20/40 - OR, 11.6 [CI, 8.0-155.6]); older age e.g. 80+ y (v < 21 y) (OR, 5.8 [CI, 3.2-10.7]); and Black race (v White) (OR, 1.8 [CI, 1.3-2.5]). Risk factors were similar for VA < 20/200 post OGR. Among all OGR patients presenting with VA 20/200 or worse, VA improved to 20/40 or better at follow up in 19% (331/1748) of patients; VA improved to better than 20/40 in only 10% (20/ 192) of Black OSR patients.

Conclusions : Our findings support previously established risk factors associated with OGR of older age and male sex and bring to light racial disparities in risk of OGI and poor visual outcomes that warrant further exploration.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.