IRIS Registry Finds New AMD, DME Population Data

William L. Rich, MD

The world’s largest clinical specialty database has returned major reports to be presented at the 121^st Annual Meeting of the American Academy of Ophthalmology (AAO 2017) in New Orleans, LA.

The Intelligent Research In Sight (IRIS) Registry, a clinical database comprised of 41 million patients and 166 million patient visits, has allowed AAO members new insight to patient outcomes, professional performance, and care processes since launching in 2014.

With its analytics covering about 11% of the total US population, the registry helped ophthalmologists report to AAO 2017 with crucial clinical reports.

One such report is that 3 similar anti-vascular endothelial growth factor (anti-VEGF) treatments for age-related macular degneneration (AMD) have similar strengths in protecting patients’ ability to see.

In a review of nearly 14,000 patients treated with a single drug type for one year, researchers found that patients achieved a similar improvement in vision across the treatment board.

Included in the study were 6,723 bevacizumab (Avastin) patients; 2,749 ranibizumab (Lucentis) patients; and 4,387 aflibercept (Eylea) patients. The patient groups received an average of 5.9, 6.4, and 6.2 injections, respectively, showing an equal rate of dosage through the studied year.

Another study of randomized, controlled trials has found that previous reports of 10% retinal disease patients to receive anti-VEGF therapy experience potentially damaging pressure rise inside the eye may be a misconeption.

Researchers reviewed 23,776 patients with AMD, diabetic macular edema (DME), or branch or central retinal vein occlusion. The studied patients had received Avastin, Lucentis, and Eylea injections, and reported notably lower pressure rise rates than expected.

A mean of 1.9% of Eylea patients reported pressure rise, while 2.8% of both Avastin and Lucentis patients reported pressure rise. Eylea’s pressure rate was considered clinically insignificant, though researchers could not explain its differentiation from the other therapies.

While anti-VEGF pressure rise rates were lower than projected, untreated DME rates were greater than believed prior to IRIS Registry analysis. About 60% of 13,410 reviewed patients received no treatment within the first year of their DME diagnosis. Though the majority of patients to receive treatment were given anti-VEGF (23.5%), almost half of them had received just 3 or fewer injections.

Researchers advised future studies focus on the possible barriers DME patients face from receiving cure.

The IRIS Registry holds potential for future population-based studies. AAO and the non-profit Research to Prevent Blindness organization announced a multi-grant fund for individual researchers interested in pursuing population-based ophthalmic studies with the massive registry, and there’s still largely untapped data.

One such open space is in glaucoma. The IRIS Registry currently has data on about 5.4 million glaucoma patients, according to AAO. The collected data includes patient disease type and severity, age, sex, race, and what surgical procedures they have had.

That said, the registry has already proven to be a valuable tool for “patients, physicians, and the health care system as a whole, William L. Rich, MD, Medical Director of Health Policy for AAO, said.

“The holy grail of health care is to improve value by enhancing patient outcomes, improving the process and experience of health care, and reducing unnecessary or ineffective care,” Rich said.