The Importance of Keeping a Broad Differen6al In Re6na Clinic: The Spectrum of Disease Seen By Re6nal Specialists in a Ter6ary Outpa6ent Clinic Se@ng Darius M. Moshfeghi 1, MD, Suzann Pershing, MD 1, Natalia Fijalkowski 1 1 Byers Eye Ins@tute, Horngren Family Vitreore@nal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California PURPOSE: To answer: Who and what do re,nal specialists in the United States see in clinic?. Table 2. Top 10 Most Common Primary Diagnoses for Pa@ents Referred to Re@nal Specialists METHODS: RESULTS : Retrospec@ve chart review of all new pa@ents referred to a re@n specialist at the Horngren Vitreore@nal Center at Byers Eye Ins@tute from January 1, 2008 to December 31, 2011. The pa@ents electronic medical records were examined for the following characteris@cs: 1) Date of service 2) Provider 3) All ICD- 9 ophthalmic diagnoses associated with the ini@al visit 4) Pa@ent age 5) Gender. Similar diagnoses were grouped together into broad diagnosis categories for analysis purposes. For example, Re@nopathy of Prematurity (ROP) category included premature screening, all stages of ROP and retrolental fibroplasia. Sta@s@cal analysis was performed using SAS 4.3. Sta@s@cal significance was set as a p- value of < 0.05. Measures of central tendency were used to describe the data and appropriate sta@s@cal tests were used to compare groups. Table 1. Baseline Characteris@cs of New Pa@ents in Re@na Clinic - Overall there was an equal gender distribu@on among new re@nal pa@ents (p=0.18) - The age distribu@ons did not change year- to- year (p=0.48) - Pa@ents over the age of 51 years old made up 61.8% of all visits - The next most common diagnoses were myopia and migrane - The number of secondary diagnoses did not change over the course of the study (P=0.38) * There was a sta@s@cally significant difference between the gender distribu@on - The age distribu@on of new pa@ents seen by ophthalmologists exhibits a bimodal distribu@on with peaks at early childhood and later decades of life. - Youngest age group had a significantly higher number of male pa@ents (p<0.001) - Higher propor@on of females in two of the eldest age groups (p<0.01 for 61-70 years and p<0.001 for 81+ years). CONCLUSIONS: Re@nal specialists treat pa@ents across the age spectrum The most common diagnoses differed by age group Diabetes is a leading cause of referral at every age group and is the primary diagnosis for pa@ents ages 11 to 70 years of age. Males are overrepresented in the youngest age groups while females are overrepresented in the elderly age groups New pa@ents have a vast spectrum of disease The familiar VINDICATE mnemonic, describing broad diagnosis categories, reminds all ophthalmologists of the miscellany of condi@ons that can have ocular manifesta@ons. This study provides important demographic and epidemiological profiles so that ter@ary ophthalmic centers can allocate resources appropriately to best address the needs of this pa@ent popula@on Table 3. The most common diagnoses in re@na clinic by disease category
The Importance of Keeping a Broad Differen6al In Re6na Clinic: The Spectrum of Ophthalmic Disease Seen By Re6nal Specialists PURPOSE: To answer: Who and what do re,nal specialists in the United States see in clinic?. METHODS: Retrospec@ve chart review of all new pa@ents referred to a re@na specialist at the Horngren Vitreore@nal Center at Byers Eye Ins@tute from January 1, 2008 to December 31, 2011. The pa@ents electronic medical records were examined for the following characteris@cs: 1) Date of service 2) Provider 3) All ICD- 9 ophthalmic diagnoses associated with the ini@al visit 4) Pa@ent age 5) Gender. Similar diagnoses were grouped together into broad diagnosis categories for analysis purposes. For example, Re@nopathy of Prematurity (ROP) category included premature screening, all stages of ROP and retrolental fibroplasia. Sta@s@cal analysis was performed using SAS 4.3. Sta@s@cal significance was set as a p- value of < 0.05. Measures of central tendency were used to describe the data and appropriate sta@s@cal tests were used to compare groups.
RESULTS Table 1. Baseline Characteris6cs of New Pa6ents Seen By Re6nal Specialists Over a Four- Year Period at a Ter6ary Academic Outpa6ent Ophthalmology Center There were five re@nal specialists in 2008, six in 2009 and seven for years 2010 and 2011 billing for new pa@ents. The distribu@on was not evenly distributed therefore median and range values are presented. 7,197 new pa@ents 7,093 had complete ICD- 9 data (98.6%) No change in age distribu@on year- by- year(p=0.48) Overall, there was no difference between propor@on of female and male pa@ents (p=0.18) in the study. 61.8% of all new re@na clinic pa@ents were over 51 years old.
RESULTS *There was a sta@s@cally significant difference between the gender distribu@on The age distribu@on of new pa@ents seen by ophthalmologists exhibits a bimodal distribu@on with peaks at early childhood and later decades of life. Youngest age group had a significantly higher number of male pa@ents (p<0.001) Higher propor@on of females in two of the eldest age groups (p<0.01 for 61-70 years and p<0.001 for 81+ years).
RESULTS Table 2. Top 10 Most Common Primary Diagnoses for Pa6ents Referred to Re6nal Specialists Diabe@c Eye Disease leading cause of re@nal specialist referral (most commonly Type 2 Diabe@c Re@nopathy) The ten most common broad diagnoses categories only accounted for 69.1% of all diagnosis codes The next most common diagnoses were myopia and migrane The number of secondary diagnoses did not change over the course of the study
CONCLUSIONS Table 3. Keeping the Differen6al Broad: The Three Most Common Diagnoses by Re6nal Specialists In Each Disease Category Re@nal specialists treat pa@ents across the age spectrum The most common diagnoses differed by age group Diabetes is a leading cause of referral at every age group and is the primary diagnosis for pa@ents ages 11 to 70 years of age. Males are overrepresented in the youngest age groups while females are overrepresented in the elderly age groups New pa@ents have a vast spectrum of disease The familiar VINDICATE mnemonic, describing broad diagnosis categories, reminds all ophthalmologists of the miscellany of condi@ons that can have ocular manifesta@ons. This study provides important demographic and epidemiological profiles so that ter@ary ophthalmic centers can allocate resources appropriately to best address the needs of this pa@ent popula@on