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How Prompt Data Curation Elucidates the Effects of COVID-19 on Real-world Practice Patterns in Ophthalmology

Author: Theodore Leng
October 2021
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The era of big data allows clinicians, medical leaders, and policymakers to make data-based decisions in response to real-world practice patterns. It should be noted that mere collection of data is insufficient. If data are organized quickly and coherently, then researchers can track real-world behavior within a timeframe near the present, thereby allowing interested parties to reach conclusions based on recent trends. In other words, if data are arranged properly, then we can learn about patterns from the past 3 months rather than a 3-month period from 2 years ago.

Two recent pieces in ophthalmic trade publications touched on this point: one by Ashley Kras, MD, MBI and me; and another by Cheryl Guttman Krader, BS, PharmD, which was reviewed by Steven D. Schwartz, MD.

The American Academy of Ophthalmology (Academy) issued guidance on March 18, 2021, that advised clinicians and surgeons, in light of the COVID-19 pandemic, to cease providing care in non-emergent and non-urgent cases. Seeking to understand if their guidance affected practice patterns, the Academy turned to data from the IRIS® (Intelligence in Research and Sight) Registry, a database in which more than 18,000 ophthalmologists and optometrists contribute real-world patient data from dozens of different electronic health record (EHR) systems. In “Intravitreal Injection Patterns During COVID-19 Pandemic,” which appeared in Ocular Surgery News, Dr. Kras and I summarized some of the Academy’s findings.  

Before the age of data curation, the Academy might have sought to understand practice patterns by performing a retrospective study of Medicare claims data. Such reviews may be cumbersome, as the databases in which claims data are stored are not finely curated and may not reflect a time period relevant to particular research interests.

Point-of-Care EHR Data Enables Quality Insights

Given that Verana Health is the data curation and analytics partner of the IRIS Registry, the EHR-derived datasets used by researchers are easier to analyze, up-to-date, and consistently formatted, thereby allowing researchers to compare real-world practice patterns for pre-specified periods before and after the Academy’s issued guidance. Among other conclusions, the researchers found evidence that: 

  • Academy members largely complied with the organization’s COVID-19 guidance 
  • Patients with retinal disease continued to receive office-based therapy
  • Gathering insights from a real-world database was feasible 

Want to learn more about the specifics? Head to this brief blog post, courtesy of Ocular Surgery News.

Building on the above work, researchers compared real-world trends and patient outcomes before and after the Academy’s guidance in greater detail. Their expanded findings were discussed in a “Probe of IRIS Registry Data Reveals Pandemic’s Impact on Ophthalmology Patient Care,” which was published in Ophthalmology Times. Among their findings were these three conclusions: 

  1. The proportion of patients receiving retinal care after the Academy’s guidance nearly doubled during the pandemic’s earliest months. Approximately 20% of ophthalmic patients received retinal care from January to March 2020. In April 2020, retina care accounted for nearly 39% of patient visits. This meant that patients who were under the routine care of a retina specialist continued to receive the care they needed. 
  2. Anti-VEGF injection rates fell during the pandemic—but not by much. In the 12-week period leading up to Academy guidance, 1.5 million anti-VEGF injections were administered. In the 12 weeks after the issuance of guidance, 1.2 million anti-VEGF injections were delivered. 
  3. Although population density did not result in any differences, regional variation in real-world practice patterns were noticeable. No differences in practice patterns were seen among urban, suburban, and rural patients, but states in the Northeast experienced a decline in patient visits during the 3-month period immediately following the Academy’s guidance.