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Overview of IRIS® Registry Real-World Analyses Shared at the American Academy of Ophthalmology 2022 Annual Meeting

Author: Durga Borkar, MD, MMCi Verana Health
December 2022
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At this year’s American Academy of Ophthalmology (Academy) 2022 annual meeting in Chicago, researchers shared a series of podium presentations and posters that leveraged the power of curated data from the Academy IRIS® Registry (Intelligent Research in Sight). The IRIS Registry is one of the largest specialty society clinical data registries in all of medicine, which has a technology foundation managed by Verana Health’s VeraQ® population health data engine. By drawing from the thousands of ophthalmic clinics that participate in the IRIS Registry, researchers, innovators, and industry partners can investigate real-world practice patterns and clinical outcomes. These insights can better inform therapeutic development strategies and patient care. 

Here’s a quick summary of the research presented: 

Overlap Analysis of Axon Registry and IRIS Registry to Compare Visual Acuity Between People with Neuromyelitis Optica and Multiple Sclerosis

Authors: Moss HE et al. 

Moss and colleagues shared data from their research demonstrating the utility of cross-registry analysis. Researchers compared visual acuity (VA) of de-identified patients with two neurologic diseases: multiple sclerosis (MS) and neuromyelitis optica (NMO). De-identified VA data were found in the IRIS Registry and patients were identified in the American Academy of Neurology Axon Registry®, a similar specialty-specific database, which also has a technology foundation that is curated and managed by Verana Health’s VeraQ population health data engine. 

Among their findings: patients with NMO had significantly worse VA than patients with MS, and use of a single registry alone identified fewer patients with each disease than an overlap analysis of both registries. More information on the study may be found here: https://www.veranahealth.com/app/uploads/2022/10/Verana_Health_Combining_Axon_and_IRIS_Data_Heather_Moss_AAO_2022_Presentation_FINAL_092722.pdf.

Real-World Safety Analysis of an Intracanalicular Dexamethasone Insert (DEXTENZA) Using the AAO’s IRIS Registry 

Authors: Chang R et al. 

Chang and colleagues presented a poster detailing the results of a real-world evaluation of safety outcomes following cataract surgery in patients who did or did not receive the dexamethasone ophthalmic insert 0.4 mg (Dextenza, Ocular Therapeutix) at the conclusion of surgery. 

In this study, researchers utilized IRIS Registry data to identify 3.7 million real-world cataract surgeries, 435,000 of which were used in this analysis. The researchers noted that their real-world data came from a broad survey of ophthalmic practices, given that the IRIS® Registry collects data from more than 16,000 physicians and more than 60 EHR systems. 

The study authors found that treatment with the dexamethasone ophthalmic insert 0.4 mg in cataract surgery “appears to have a favorable safety profile” and that analyses such as these “can help inform post-market safety.” You can find details about real-world rates of uveitis, corneal edema, cystoid macular edema, epiphora, and lacrimal disorders in patients who did and did not receive the steroid insert at this link: https://www.veranahealth.com/app/uploads/2022/10/AAO-2022_DEXTENZA-IRIS-Registry-Study_Chang_FINAL-1.pdf 

Real-World Patient Demographics & Clinical Characteristics of an Intracanalicular Dexamethasone Insert (DEXTENZA) Using IRIS Registry

Authors: Mbagwu M et al. 

In a similar study to that of Chang and colleagues, Mbagwu and colleagues shared an on-demand ePoster that characterized the demographics and clinical comorbidities of real-world cataract surgery patients who did and did not receive the dexamethasone ophthalmic insert 0.4 mg using data from the IRIS Registry. 

Topline outcomes from this research include: 

  • Identifying mean age (73.44 years) and Medicare recipient status (74.5%) of all cataract surgery patients in the defined time period (June 1, 2019 through March 31, 2021)
  • Determining that the dexamethasone ophthalmic insert 0.4 mg was used more frequently in patients diagnosed with dry eye and other ocular surface conditions
  • Characterizing the low rates of glaucoma and age-related macular degeneration (AMD) in patients who received the dexamethasone ophthalmic insert 0.4 mg

Detailed results from this ePoster can be explored here: https://www.veranahealth.com/app/uploads/2022/10/AAO-2022_DEXTENZA-IRIS-Registry-Study_Mbagwu_FINAL-1.pdf

Clinical Trial Emulation of the Comparison of AMD Treatment Trials (CATT) Using Data from the IRIS® Registry (Intelligent Research in Sight)

Authors: Borkar DS et al. 

In another on-demand ePoster, my colleagues and I (DSB) presented the outcomes of our real-world emulation of the pro re nata (prn, or as-needed) treatment arms of the Comparison of AMD Treatments Trials (CATT) using data from the IRIS Registry.

The CATT was a landmark study in ophthalmology that compared treatment with either ranibizumab (Lucentis, Genentech) or bevacizumab (Avastin, Genentech) for the treatment of neovascular AMD. Our team identified 530,000 patients in the IRIS® Registry who received treatment for neovascular AMD from 2015 to 2019. Of that group, 425 eyes that received ranibizumab and 767 eyes that received bevacizumab fit the CATT protocol treatment criteria sufficiently enough to emulate the prn treatment arms in the CATT. 

Consistent with what we know about differences in real-world and clinical trial outcomes, the real world prn treatment arms generated using IRIS Registry data underperformed their clinical trial counterparts in terms of visual acuity improvements. Specifics of our findings can be found here: https://www.veranahealth.com/app/uploads/2022/10/AAO_2022_Poster_Web-2.pdf

Importantly, this study found that real-world data from the IRIS Registry may be used to emulate clinical trial arms, allowing opportunities to identify differences and similarities among patient characteristics and outcomes in the real world compared with those in tightly controlled clinical trials. 

Eyecelerator Presentation

Presenter: Borkar DS

In addition to the papers and posters outlined above, I was invited to take to the podium to share with my colleagues how the IRIS Registry could help impact the diagnosis and treatment of AMD at the pre-Academy Eyecelerator meeting, an event dedicated to networking for clinician-scientists and investors. During this presentation, I discussed how the depth and breadth of the IRIS Registry (e.g., 75+ million unique de-identified patients, 9 years of longitudinal data) can help impact clinical care and innovation in AMD. I also shared the tremendous impact of including imaging data in the IRIS Registry on generating valuable insights. As our therapeutic options for AMD continue to grow, the IRIS Registry has the ability to guide clinicians in providing the right treatment to the right patient at the right time based on real-world clinical outcomes. 

More to Come

Readers can expect to hear more about how curated data from the IRIS Registry will help inform ophthalmology’s understanding of real-world treatment patterns and patient outcomes. Verana Health continues to curate the database as it grows in scope and complexity–including with the contribution of diagnostic images– thereby allowing researchers and industry partners committed to innovation to efficiently access high quality, curated real-world data across a wide range of conditions and treatments. 

Durga S. Borkar, MD, MMCi, is a Medical Advisor at Verana Health, and is a practicing vitreoretinal surgeon and Assistant Professor of Ophthalmology at the Duke Eye Center.