Vitreoretinal Specialist Use of Ancillary Testing: An IRIS^® Registry Analysis

Abstract

Purpose

To investigate patterns of ancillary imaging testing among vitreoretinal specialists for patients with vitreoretinal disease in the United States (US).

Methods

Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA), ordered by vitreoretinal specialists and documented within the American Academy of Ophthalmology IRIS^® Registry (Intelligent Research in Sight) between 01 January 2018 and 31 December 2020, were retrospectively assessed. Trends in imaging modality choice were analyzed by payer type, geographic region, and practice type. Sub-analyses were conducted according to categorization of vitreoretinal specialists into those treating a high versus low volume of patients with neovascular age-related macular degeneration (nAMD).

Results

OCT was the most common imaging modality used, followed by CFP and FA. Following normalization, the highest volume of OCT procedures performed were identified among Medicare Advantage and Medicare Fee-for-Service beneficiaries, within the South of the US, and at medium and large practices. Minimal differences were observed for CFP and FA volume across payer types and regions. Across practice types, the largest volume of CFP and FA procedures were identified in small and private equity owned practices, respectively. Vitreoretinal specialists with a high nAMD volume more frequently performed OCT than those with a low nAMD volume.

Conclusion

Vitreoretinal specialists demonstrated a strong preference for OCT, with real-world associations according to payer type, geographic location, and practice type. Volume of nAMD patients seen impacted the likelihood of specialists ordering OCTs.

Plain Language Summary

Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA) are key imaging modalities used by vitreoretinal specialists in routine eye care. This study aimed to uncover patterns of OCT, CFP, and FA usage in the United States from 2018 to 2020, and investigated the impact of volume of patients with neovascular age-related macular degeneration on these trends. Higher rates of OCT use, compared with CFP and FA, were identified in the US.

Keywords:

• color fundus photography
• fluorescein angiography
• optical coherence tomography
• retinal disease
• vitreoretinal disease

Abbreviations

AMC, academic medical center; CFP, color fundus photography; CPT, Current Procedural Terminology; EHR, electronic health records; FA, fluorescein angiography; ICD, international classification of disease; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; VEGF, vascular endothelial growth factor; US, United States.

Data Sharing Statement

Data from the IRIS Registry is accessible via the Academy. More information is available at https://www.aao.org/iris-registry.

Ethics Approval and Informed Consent

This study was approved by the Western Institutional Review Board-Copernicus Group (WCG^® IRB). Patient consent was not required for this study due to the de-identified nature of the data extracted from the IRIS Registry.

Acknowledgments

Writing and editorial support were provided by Rebecca Watkin, PhD (CHB Wordsmith, Inc).

Disclosure

SV, AL, and MM are employees of Verana Health. DB is a consultant for AbbVie/Allergan, Glaukos, Genentech, Iveric Bio, and Verana Health. TL reports receiving grants and contracts from Astellas, consulting fees from Alcon, Apellis, Graybug, Regeneron, Boehringer Ingelheim, Kanaph, Nanoscope Therapeutics, Protagonist Therapeutics, Roche/Genentech, and Verana Health. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research was funded in part by a National Institute of Health (NIH) grant (P30-EY026877) and was supported by the Research to Prevent Blindness non-profit organization.