A comprehensive model for measuring real‐life cost‐effectiveness in eyecare: automation in care and evaluation of system (<i>aces‐rwm™</i>)

Tuulonen, Anja; Kataja, Marko; Aaltonen, Vesa; Kinnunen, Kati; Moilanen, Jukka; Saarela, Ville; Linna, Miika; Malmivaara, Antti; Uusitalo‐Järvinen, Hannele

doi:10.1111/aos.14959

Cited by 9 publications

(18 citation statements)

References 39 publications

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“…12 It is widely acknowledged how different conclusions continue to be drawn from same and expanding evidence, depending on different cultures and decision-making policies. 13 This applies not only to ISBCS but also to the selection of antibiotics for prophylaxis of endophthalmitis. The 2017 Cochrane review found five studies meeting the inclusion criteria for reviewing perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

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Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations

et al. 2022

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Background/aimsTo assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland.MethodsAll cataract surgeries performed between 1 January 2008 and 31 December 2020, and all endophthalmitis cases during the same period were searched from electronic patient records. Numbers and frequencies of ISBCS, and complications, including endophthalmitis and vitreous loss, were recorded and compared with unilateral operations.ResultsThe study included 56 700 cataract surgeries in 34 797 patients of whom 39% (n=13 445) had ISBCS. The median age of the patients was 75 (IQR 68–80, range 0.08–99) years at the time of surgery. The proportion of ISBCS patients increased from 4.2% in 2008 to 46% in 2020. Vitreous loss occurred in 480 (0.9%) of cataract surgeries. There were no postoperative endophthalmitis after cataract surgery (n=0) during the 13-year period.ConclusionThe proportion of patients undergoing ISBCS increased from 4.2% in 2008 to 46% in 2020. No endophthalmitis were found to be associated with ISBCS.

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Section: Discussionmentioning

confidence: 99%

“…As current information technologies allow automated recording of the important parameters and clinical measures, all real-world data need to become available for national and international benchmarking purposes in search for optimal level of care within an affordable healthcare system. 13…”

Section: Discussionmentioning

confidence: 99%

Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations

et al. 2022

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“…This study is a sub-analysis of real-world data (RWD) collected for the 'Big 4' eye diseases which are AMD, glaucoma, diabetic retinopathy and cataract, containing overall 195 300 interventions in 2008-2020 in Tays Eye Centre, Tampere University Hospital, Finland (Tuulonen et al, 2021). For this single-center retrospective analysis, we included RWD collected manually from electronic medical records of all patients with 1) an ICD-10 code for nAMD (H35.31) and ≥1 CKD05-code for an intravitreal injection, and 2) patients with an ICD-10 code for glaucoma (H40.1, H40.2, H40.3, H40.4, H40.5, H40.6, H40.8, H40.9) and ≥1 visit in Tays Eye Centre, between 1 January 2008 and 31 December 2017.…”

Section: At Er I a L S A N D M Et Hod Smentioning

confidence: 99%

“…Age-related macular degeneration and glaucoma are the most common causes for permanent visual impairment in developed countries, including Finland (Resnikoff et al, 2004;Tuulonen et al, 2021). Glaucoma may be more common among patients with neovascular agerelated macular degeneration (nAMD) than without nAMD (Hu et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Glaucoma progression in patients receiving intravitreal anti‐VEGF treatment for neovascular age‐related macular degeneration

Pirinen

Leinonen

Helminen

et al. 2022

Acta Ophthalmologica

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The purpose of this study was to investigate how often glaucoma and neovascular age-related macular degeneration (nAMD) occur in the same patient and to evaluate whether glaucoma progression is faster in eyes treated with intravitreal anti-VEGF medications for nAMD. Methods: This single-centre retrospective real-world data (RWD) consists of medical records of 6314 glaucoma and 2166 nAMD patients treated in 2008-2017 in Tays Eye Centre, Finland. To study glaucoma progression, changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) were compared in glaucoma eyes with and without anti-VEGF treatment for nAMD and ≥1 year follow-up. Results: During the 10-year period, 147 patients with glaucoma received intravitreal anti-VEGF treatment for nAMD corresponding to 2% of glaucoma and 7% of nAMD patients. The mean change in MD was −0.70 dB/year (SD 1.8) vs. −0.27 dB/ year (SD 1.7) (p = 0.027) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively. In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at −0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5) (p = 0.654), and glaucoma progression was detected in 14/20 vs 10/20 (p = 0.219) fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes. Conclusion: nAMD and glaucoma were found co-existing in the same eye at rates that were similar to the age-corrected prevalence of the two diseases in the general population. Our results suggest that intravitreal anti-VEGF treatment for nAMD may accelerate glaucoma progression.

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“…For example, patients in everyday practices have two eyes with variable comorbidities and may be cared by practitioners with unwarranted variations in the delivery of eye care (MacEven et al, 2019).When targeting to improve the real-world costeffectiveness, what is done clinically in everyday practices needs to be measured and evaluated routinely, efficiently and non-selectively (WHO, 2023). Therefore, the Finnish University Eye Clinics have developed a holistic, yet simple and comprehensible aces-rwm™ ecosystem model (automation in care and evaluation of system with real-world monitoring) to deal with complex challenges in everyday eye care (Tuulonen et al, 2022). The overall aim of the ecosystem is to produce the best possible well-being and eyesight with the available resources.…”

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confidence: 99%

A prototype protocol for evaluating the real‐world data set using a structured electronic health record in glaucoma

Sulonen,

Leinonen,

Lehtonen

et al. 2023

Acta Ophthalmologica

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PurposeAs the first step in monitoring and evaluating day‐to‐day glaucoma care, this study reports all real‐world data recorded during the first full year after the implementation of a prototype for glaucoma‐specific structured electronic healthcare record (EHR).MethodsIn 2019, 4618 patients visited Tays Medical Glaucoma Clinic at Tays Eye Centre, Tampere University Hospital, Finland, that serves a population of 0.53 M. Patient data were entered into a glaucoma‐specific EHR by trained nurses to be checked by glaucoma specialists. Tays Eye Centre follows the Finnish Current Care Guideline for glaucoma in which glaucoma is defined using a ‘2 out of 3’ rule, that is, ≥2 findings evaluated as glaucomatous in optic nerve head (ONH), retinal nerve fibre layer (RNFL) and visual field (VF).ResultsThe clinical evaluations of ONH, RNFL and VF were recorded in 95%–100% of all eyes. ONH was evaluated as glaucomatous more often (44%) than RNFL (33%) and VF tests (30%). Progressive changes in any of the three tests were recorded in 35% of the ‘≥2/3 glaucoma group’ compared to 2%–9% in the other groups. The mean IOP at visit was 15 mmHg. The mean target IOP was 17 mmHg, and it was recorded in 94% of eyes.ConclusionThe developed structured data presentation enables comparisons between different population‐based real‐world glaucoma data sets and glaucoma clinics. Compared to a data set from the UK, the proportion of glaucoma suspicion‐related visits was smaller in Tays Eye Centre and test intervals were longer.

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A comprehensive model for measuring real‐life cost‐effectiveness in eyecare: automation in care and evaluation of system (aces‐rwm™)

Cited by 9 publications

References 39 publications

Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations

Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations

Glaucoma progression in patients receiving intravitreal anti‐VEGF treatment for neovascular age‐related macular degeneration

A prototype protocol for evaluating the real‐world data set using a structured electronic health record in glaucoma

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