Open-Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014 – 2018: Incidence, Risk Factors, and Visual Outcomes

Purpose: To estimate incidence and evaluate demographic risk factors and visual acuity (VA) outcomes of open-globe injuries requiring surgical repair in the IRIS® Registry (Intelligent Research in Sight). Design: Retrospective cohort study. Participants: Patients with open-globe injury repairs (OGRs) were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, and 65265) from 2014 through 2018 in the IRIS Registry. Methods: Logistic regression models adjusting for age, sex, race, ethnicity, United States region, concurrent and subsequent surgeries, and baseline VA. Main Outcome Measures: Outcomes included annual and 5-year incidence rates per 100 000 people and factors associated with OGR, VA better than 20/40, and VA of 20/200 or worse at final follow-up (3–12 months after OGR). Results: Thirteen thousand seven hundred sixty-six OGRs were identified; 5-year cumulative incidence was 28.0 per 100 000 patients. Open-globe repair was associated with age 21 to 40 years compared with younger than 21 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.5–1.7]), male sex (OR, 2.8; 95% CI, 2.7–2.9), Black versus White race (OR, 1.3; 95% CI, 1.2–1.4), Hispanic versus non-Hispanic ethnicity (OR, 1.7; 95% CI, 1.6–1.8), and South (OR, 1.4; 95% CI, 1.3–1.5) and West (OR, 1.3; 95% CI, 1.2–1.4) versus Midwest regions and associated inversely with Asian versus White race (OR, 0.6; 95% CI, 0.6–0.7). Visual acuity outcomes, analyzed in a subset of 2966 patients with VA data available, showed vision impairment (VA < 20/40) at final follow-up was associated with VA of 20/200 or worse at presentation (20/200 better than 20/40; OR, 11.1; 95% CI, 8.0–15.7), older age (e.g., > 80 years vs. < 21 years; OR, 5.8; 95% CI, 3.2–10.7), and Black versus White race (OR, 1.8; 95% CI, 1.3–2.6). Risk factors were similar for VA of 20/200 or worse after OGR. Among the 1063 patients undergoing OGR with VA of 20/200 or worse at presentation, VA did not improve to better than 20/200 at follow-up in 35% of patients (1063/2996). Conclusions: Our findings bring to light racial disparities in risk of OGR and poor visual outcomes that warrant further exploration. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.