ARVO 2023 Roundup: Verana Health’s Curated IRIS Registry Data in Action


Durga Borkar, MD, MMCi Verana Health

At this year’s Association for Research in Vision and Ophthalmology (ARVO) annual meeting, researchers with an interest in retinal disease presented several papers and posters that demonstrated the potential of curated datasets in modern medicine. Central to each of these efforts is the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight). Verana Health is the exclusive end-to-end data curation and analytics partner for the Academy’s IRIS Registry, which is an ophthalmology-specific database comprised of real-world, de-identified patient data derived from electronic health records (EHRs). The IRIS Registry is one of the largest specialty clinical data registries in medicine, containing ophthalmic records from more than 78 million unique patients, more than 490 million billable patient encounters, and nearly 16,000 contributing ophthalmologists and other eye care providers across the U.S. Verana Health de-identifies, normalizes, harmonizes and curates these data from both structured EHR fields and unstructured physician notes, thereby providing researchers with  up-to-date real-world insights. 

Here, I offer bite-sized summaries of four presentations from this year’s ARVO annual meeting that relied on the power of the IRIS Registry. If you’re a retina professional conversant in that subspecialty’s lexicon, skip to the summaries below. For those who need a refresher on retinal disease, use this quick primer: 

  • Patients with age-related macular degeneration (AMD) often first present with dry AMD in early and intermediate stages of the disease. When they progress to the advanced stage, they are subtyped as having neovascular AMD (also called wet AMD, wherein leakage from new blood vessels in the back of the eye disrupts visual acuity) or geographic atrophy (also called GA, wherein atrophic lesions that develop on the retina disrupt vision). 
  • Patients with diabetes may develop a related sight threatening complication called diabetic macular edema (also called DME), which results in retinal edema and visual complications. 
  • Neovascular AMD and DME may be treated with anti–vascular endothelial growth factor (anti-VEGF) injections, and GA may be treated with a newly approved agent targeting the complement system. All treatment injections are intravitreal (i.e., injected into the vitreous cavity). 

Now, on to a summary of select ARVO presentations. 

Geographic Atrophy Diagnosis in the IRIS® Registry: A Comparison Between Images and ICD-10 Codes

Presenter: Zhongdi Chu, PhD

Researchers sought to compare the agreement between two entities: real-world GA diagnosis codes and a pair of retina specialists who graded images of GA patients. Specifically, the research team wanted to know if diagnoses of GA with subfoveal involvement matched graders’ assessment of images.

All patient profiles reviewed were de-identified in the IRIS Registry and included images from three distinct imaging modalities.

Automated Identification of Geographic Atrophy Eyes With and Without Subfoveal Involvement Using Machine Learning and Real-World Ophthalmic Images in the IRIS® Registry

Presenter: Zhongdi Chu, PhD

Patients with dry AMD and/or GA were identified by ICD-9 or ICD-10 codes in the IRIS Registry, and optical coherence tomography (OCT) images from those patients were split into three groups: a training set, a validation set, and a testing set. OCT Images were entered into a machine-learning algorithm to train, validate, and test for identifying GA eyes with and without subfoveal involvement – an indication of disease severity. 

How effective was the algorithm at being trained, at validating images, and at correctly identifying GA using only patient OCT scans?

Early Treatment Patterns and Outcomes in Patients with Neovascular Age-Related Macular Degeneration Initiating Faricimab: An IRIS® Registry Analysis

Presenter: Durga Borkar, MD, MMCi

Faricimab (Vabysmo, Genentech) is the newest anti-VEGF agent to be approved by the FDA. To learn more about treatment patterns in real-world use, researchers searched the IRIS Registry for patients with wet AMD who received at least 1 dose of faricimab within its first 7 months on the market. 

In all, more than 12,100 eyes with wet AMD from approximately 10,500 patients were treated with faricimab, with a mean 2.6 injections administered over a mean 55.1 days of follow-up. Want to learn what the researchers found regarding treatment-naïve status of patients, how vision improved for these patients, and whether patients were able to experience a longer interval between treatments?

Early Treatment Patterns and Outcomes in Patients with Diabetic Macular Edema Treated with Faricimab: The FARETINA-DME Study

Presenter: David, Tabano, PhD

Faricimab can also be used to treat DME. Investigators in this study used similar methods to those outlined above, this time seeking to understand real-world use of faricimab for DME therapy in the earliest months of the drug’s approval. 
Nearly 2,400 eyes with DME in approximately 1,900 patients were identified as having received at least 1 faricimab injection for DME treatment. Some top-line treatment patterns were similar to those seen in the related wet AMD study, with mean 2.4 treatments occurring over a mean 55.2 days.

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