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Using Real-World Evidence to Investigate Surgical Outcomes

Author: Verana Health
July 2019

In a recent study, Verana Health partnered with researchers to examine real-world clinical outcomes of patients who received a trabeculectomy using data from the American Academy of Ophthalmology IRIS® Registry, which contains six-year longitudinal data from over 52 million patients across the United States. Although numerous large cohort reports of long term complications have been published, the IRIS Registry is uniquely positioned to offer new insights given the unprecedented size and depth of its clinical datasets and the heterogeneity of patient demographics and practice locations.

Why was Verana involved?

In this study, researchers collaborated with Verana to determine postoperative trabeculectomy outcomes, which can set the stage for future research to identify potential areas in which glaucoma management can be improved. Real-world evidence on the outcomes of surgical interventions for glaucoma is difficult to obtain through traditional methods. However, through a partnership with the American Academy of Ophthalmology, Verana can generate real-world evidence on patient outcomes from longitudinal data contributed to the IRIS Registry. For an ophthalmic study such as this one, it is necessary to use clinical data such as laterality and intraocular pressure (IOP) measurements, often only found in the unstructured notes in EHRs. Verana’s algorithms are able to extract, process, and tag text while taking note context into account to accurately standardize and classify this information. 

What did Verana do?

Using the IRIS Registry, Verana discerned that 7,616 patients fit the inclusion and exclusion criteria for this study and evaluated IOP at multiple time periods post-surgery to determine real-world outcomes following trabeculectomies. Using de-identified data from the registry and advanced analytics based on deep domain knowledge in ophthalmic care, Verana and the study investigators were able to conduct this as a non-interventional and retrospective study that is representative of the broader trabeculectomy patient population.This method is in contrast with prospective randomized controlled trials that are often used for outcomes studies which may be limited in size and diversity of geography and socioeconomics.

What did Verana find?

In this study, Verana found a decrease in IOP of 8.7mm/Hg two years after surgery, demonstrating the efficacy of trabeculectomy surgery in lowering IOP in a real-world setting. Based on these findings, future studies can look further into confounders that influence IOP change and the comparative effectiveness of other types of treatments. This study also provides a launchpad to delve deeper into the patient population receiving trabeculectomies; while this analysis specifically examined how effective trabeculectomy is for IOP control, it is now possible to look into which types of patients would be suitable for other types of therapies. 

In Conclusion

By analyzing real-world data from sources like the IRIS Registry, Verana can retrospectively measure patient outcomes and treatment effectiveness in a way that isn’t possible with claims data or other more limited clinical data sources in ophthalmology. Verana’s insights using large-scale real-world data provide a big-picture view of traditional treatment approaches. These analyses not only identify areas for change and generate further hypotheses to improve patient care but also open the door to learn about the patient populations in need of treatment and to evaluate the best method of care for all patients.

The study “Real-World Treatment and Outcomes Following Trabeculectomy in US Clinical Practice: An Analysis of the AAO IRIS Registry” was presented at the World Glaucoma Congress in April 2019.