Public Health and Ophthalmic Diseases: Cutting edge discoveries and grand possibilities
Denver, Colo.—Numerous factors can compromise an individual, a family, a community, or a nation’s health. Sometimes these elements are already known, other times they are hidden. Four studies presented this week at the 2022 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Denver, Colo. examine some of these factors, their impact on eye health, and recommended interventions. A few interventions will require technological advances while others will require more further research. All studies will discuss the most important component needed, collaboration.
New real-world data study uncovers racial and insurance status disparities in outcomes of diabetic eye disease treatment
The rates of diabetic macular edema (DME) and diabetic retinopathy (DR) are rising globally. Research has shown that Hispanic and Black patients exhibit worst baseline visual acuity (VA) outcomes when they commence treatment relative to White patients. Researchers at Stanford University, Midwest Eye Institute, the American Academy of Ophthalmology (AAO), and Indiana University School of Medicine conducted a study to examine insurance and race-based differences in treatment and vision outcomes of Black, Hispanic, and White patients with DR/DME.
Jay Maturi, lead researcher, and team used data from the Intelligent Research in Sight Registry (IRIS) to examine VA outcomes over two years and the differential treatment of patients with anti-VEGF agents. Their study included 43,273 eyes and found that after one and two years, White patients experienced greater improvements in vision following treatment in comparison to Black and Hispanic patients. They also observed that across all levels of disease severity, Hispanic patients were more likely to be put on bevacizumab treatment for DME and DR as compared to White patients.
Maturi said “it may be possible to remedy these disparities through strong improvements to diabetic screening programs, provider awareness of race and insurance-based differences in care, and continued research on more durable therapies."
- Abstract title: Race and Insurance based differences in the outcome of anti-vascular endothelial growth factor treatment of diabetic retinopathy - an analysis of 43,274 patient eyes using the IRIS® Registry (Intelligent Research in Sight)
- Presentation start/end time: Sunday, May 1, 2:45 – 4:45pm MT
- Location: Virtual (https://arvo2022.arvo.org/)
- Abstract Number: 565 – A0130
The need for further enhancement of AI capabilities in Ophthalmology
Since the outbreak of coronavirus disease-19 (COVID-19) from more than two years ago, a bright light has been shed on the global health infrastructure and how unprepared we have been in not just preventing a pandemic, but in providing necessary services to patients struggling with chronic ailments such as visual impairment due to diabetes. Many advances have been made during these years, especially technological advances, yet further advances are needed. This is also prevalent in tele-ophthalmology resources.
Eric Kuklinski, BA, MS, and other researchers from Rutgers New Jersey Medical School compared the results of artificial intelligence (AI) in diagnosing and grading diabetic retinopathy (DR) to in-person retinal examinations by retina specialist and to tele-ophthalmology. They believe AI can be a great asset to physicians in screening for DR in times of pandemic, remote areas, or clinics where specialists are not available.
The researchers evaluated forty patients (80 eyes) from an urban retina clinic who underwent retinal examination and DR grading by a retina specialist. Fundus photos were taken by Canon CR-2 Plus AF Retinal Imaging camera and the retinal images were graded by a retina specialist as per the International Clinical Diabetic Retinopathy (ICDR) classification scale through tele-ophthalmology (Tele). The same retinal images were sent for DR grading by the AI software, EyeArt (Eyenuk, CA), producing a grade of normal, mild DR, or more than mild DR.
Kuklinski and team found that the AI software “had a substantial rate of agreement with the in-person clinical examination and near perfect agreement with Tele. Tele grading was in near perfect agreement with the in-person diagnosis.” There were 11 and 26 eyes that were unable to be graded by Tele and AI, respectively. They expressed a need for further improvements on Tele and AI to reduce the number of ungradable images but don’t see this as a setback. “AI is an evolving technology that has the potential to reliably screen for Diabetic Retinopathy, diagnose diabetic changes early and expedite referral to Ophthalmologists.” said Kuklinski, “AI will expand the capabilities of Tele-ophthalmology and provide an invaluable resource in triaging patients with the highest need especially in medically stressful times as in a pandemic.”
- Abstract title: Agreeability of Tele-ophthalmology and Artificial Intelligence-Based Diagnosis of Diabetic Retinopathy
- Presentation start/end time: Monday, May 2, 10am – 12pm MT
- Location: Virtual (https://arvo2022.arvo.org/)
- Abstract Number: 1383 – A0079
The lasting impact of an illegal discriminatory practice on US minority eye health
Researchers investigate an U.S. public health racial issue, redlining, and if it has an association with visual impairment and blindness (VIB). Redlining is the discriminatory practice started around the 1930s where services (usually financial) are denied to residents that live in certain areas/neighborhoods that are deemed “hazardous” to investment. These areas have a substantial number of racial and ethnic minority groups. The practice was a type of residential segregation and even though it is now illegal, its impact remains.
Lead researcher Patrice Hicks, MPH, PhD, and a team consisting of researchers from the Kellogg Eye Center, University of Michigan, Moran Eye Center, and the University of Utah gathered census tract-level data from the American Community Survey that included median age, population size, percent of answerers by tract who had VIB, race, sex, and state. They procured average redlining scores per census tract (CT) from the Open Inter-university Consortium for Political and Social Research (OpenICPSR). Then, they used logistic regression to estimate “the effect of redlining on the probability of a” census tract (CT) “having a rate of VIB greater than the national average” and linear regression to “estimate the effect of redlining on the logarithm of average VIB.”
Hicks and team included 12,227 CTs with redlining scores and that poorer redlining scores were associated with greater increased chances of blindness and visual impairment above the national average. This is after they controlled for the population of the census tract, age, sex, race, and state. More studies are needed to evaluate if there are associations within a variety of eye conditions and at the individual patient level. Nevertheless, Hicks said that this “study highlights that a person’s neighborhood and its history of segregation impacts current eye health outcomes. To achieve equity in vision health, policies that address racial and socioeconomic segregation are needed."
- Abstract title: The Association between Redlining, Visual Impairment and Blindness
- Presentation start/end time: Monday, May 2, 3 – 5pm MT
- Location: Poster Hall (Denver Convention Center/Virtual)
- Also available on the virtual meeting site at https://arvo2022.arvo.org/ beginning May 1
- Abstract Number: A0161
Call for interventions in preventing and treating ophthalmic eye illnesses and injuries in the homeless population
Little research has been conducted on how health hazards that homeless individuals encounter could affect their eye health. It is crucial to assess this populace especially since they contact health dangers that are disparate from the general population. Hence, researchers from the Mayo Clinic conducted their study on homeless individuals that were hospitalized for eye disease and injury.
They gathered data from a national database, the National Inpatient Sample (NIS) database, to establish which ophthalmic diseases and injuries were the ones that got homeless individuals hospitalized most often. The most common diagnoses were corneal ulcer, orbital floor fracture, laceration of the eyelid, orbital cellulitis, and endophthalmitis. Among the general populace, they found that there are lower rates of trauma-related diagnoses (23%) relative to the homeless population (38%).
Lead research Michal Turkiewicz, BA said that “this is the first project to study ophthalmic disease among individuals experiencing homelessness using a national database. It shows they experience greater rates of eye trauma and demonstrates the need for targeted interventions to reduce eye injuries in this population.”
- Abstract title: Primary ophthalmic hospitalizations among individuals experiencing homelessness in the United States, 2016-2018
- Presentation start/end time: Monday, May 2, 3 – 5pm MT
- Location: Poster Hall (Denver Convention Center/Virtual) Also available on the virtual meeting site at https://arvo2022.arvo.org/ beginning May 1
- Abstract Number: A0169
The Association for Research in Vision and Ophthalmology (ARVO) is the largest eye and vision research organization in the world. Members include approximately 10,000 eye and vision researchers from over 75 countries. ARVO advances research worldwide into understanding the visual system and preventing, treating and curing its disorders. Learn more at ARVO.org.
The 2022 ARVO Annual Meeting will take place in Denver, Colo. from May 1 – 4 and virtually May 11 - 12. The Meeting is the premiere gathering of nearly 10,000 eye and vision researchers from around the world. During the Meeting, 4,800 abstracts will be presented on the latest basic and translational research in eye and vision science.
All abstracts accepted for presentation at the Annual Meeting represent previously unpublished data and conclusions. This research may be proprietary or may have been submitted for journal publication. Embargo policy: Journalists must seek approval from the presenter(s) before reporting data from paper or poster presentations. Press releases or stories on information presented at the ARVO Annual Meeting may not be released or published until the following embargo dates:
- May 1: Official launch of presentations of all posters (both presented in-person and virtually)
- Rolling basis: Paper session, Symposia, Minisymposia, Cross-sectional Groups, and invited speaker sessions that have specific presentation times will be embargoed until the end of those individual time slots.