ARVO 2014 Annual Meeting Abstracts

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1 539 Visual impairment, health care delivery, and screening Thursday, May 08, :00 PM 1:45 PM Exhibit/Poster Hall SA Poster Session Program #/Board # Range: /A0206 A0235 Organizing Section: Clinical/Epidemiologic Research Program Number: 6079 Poster Board Number: A0206 PREVALENCE AND CAUSES OF VISION IMPAIRMENT AND BLINDNESS IN OLDER ADULTS IN AN URBAN CENSUS SECTOR OF PARINTINS, BRAZILIAN AMAZON REGION Joao M. Furtado 1, 2, Sergio Munoz 3, Adriana Berezovsky 1, Marcos J. Cohen 4, 5, Jacob M. Cohen 4, 5, Paulo H. Morales 1, Nivea Nunes Cavascan 1, Sung E. Watanabe 1, Rubens Belfort, Jr. 1, Solange R. Salomao 1. 1 Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil; 2 Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, Brazil; 3 Departamento de Salud Publica, Universidad de La Frontera, Temuco, Chile; 4 Instituto de Olhos de Manaus, Manaus, Brazil; 5 Departamento de Cirurgia, Setor de Oftalmologia, Faculdade de Medicina, Universidade Federal do Amazonas - UFAM, Manaus, Brazil. Purpose: To investigate prevalence and causes of vision impairment/ blindness in older adults from an urban census sector of Parintins, Brazil Methods: An urban census sector was conveniently chosen for its proximity to the eye clinic for ophthalmic assessment. Subjects were enumerated through a door-to-door survey and those with ages 45 years and older were invited for measurement of presenting and best-corrected visual acuity and an ocular examination. The principal cause of visual impairment/blindness was identified for eyes with presenting visual acuity less than 20/32 Results: A total of 178 eligible persons in 136 households were enumerated, and 144 (80.9%) examined. The prevalence of presenting visual acuity>20/32 in both eyes was 70.7% (95% confidence interval [CI]: 60.2% %), and 79.5% (95% CI: 71.0% %) with best correction. The prevalence of presenting visual impairment (<20/63->20/200) in the better eye was 20.7% (95% CI: 12.9% %), and 15.4% (95% CI: 9.4% %) with best correction. The prevalence of presenting bilateral blindness (<20/200 in both eyes) was 8.70% (95% CI: 3.8% %), and 5.13% (95% CI: 1.9% %) with best correction. Presenting and best-corrected blindness and vision impairment were associated with lack of schooling and older age. Cataract (27.6%), retinal disorders (20.7%) and corneal scar/opacities (13.8%) were the most common causes of blind eyes. Uncorrected refractive errors (40.4%) and cataract (40.4%) were the main causes of vision impairment<20/63 to >20/200, with uncorrected refractive errors (85.4%) and cataract (12.2%) as main causes of mild vision impairment <20/32 to 20/63 Conclusions: The current results indicate that visual impairment and blindness is a significant problem in older adults from this small urban area of the Brazilian Amazon region. Blindness and vision impairment prevalence from this area was four to five times higher than those found in a previous population-based study in a large urban area of Sao Paulo, Brazil. There is an urgent need to implement prevention of blindness programs for older adults with emphasis on those without schooling Commercial Relationships: Joao M. Furtado, None; Sergio Munoz, None; Adriana Berezovsky, None; Marcos J. Cohen, None; Jacob M. Cohen, None; Paulo H. Morales, None; Nivea Nunes Cavascan, None; Sung E. Watanabe, None; Rubens Belfort, Jr., None; Solange R. Salomao, None Support: Conselho Nacional de Pesquisa e Desenvolvimento Tecnológico, CNPq, Brasilia, Brasil, Programa Ciência sem Fronteiras grant to SRS, scholarship to SM and post-doctoral scholarship to JMF; Lions Club International Foundation, Sight First Grant to SRS Program Number: 6080 Poster Board Number: A0207 Prevalence and Causes of Visual Impairment and Blindness in an Urban Population: The South Brazilian Bocaiuva Study Lisandro Sakata, Viviane M. Sakata, Ana L. Rocha, Gustavo Sakuno, Andre Mozena, Patricia Watanabi, Thais Nakayama, Mario Sato, Ana Tereza R. Moreira, Kenji Sakata. Universidade Federal do Parana, Curitiba, Brazil. Purpose: To describe the prevalence and causes of visual impairment and blindness in an urban Brazilian population. Methods: All subjects over 40 years old living in the urban part of Bocaiuva city were selected and invited to participate in this population-based study. Participants underwent standardized ophthalmic assessments for visual impairment and blindness, using best-corrected visual acuity (BCVA), and presenting visual acuity (PVA), according to the modified World Health Organization (WHO) definitions. Unilateral blindness was defined based on the worse eye, and bilateral visual impairment or blindness was defined on the basis of the better eye. Visual impairment was defined as VA <20/60 but 20/400, and blindness was defined as VA < 20/400. Primary causes of visual impairment and blindness were determined. Results: A total of 1211 eligible individuals (78.6% response rate) participated, whereas 791 (65.3%) self-reported as White, and 385 (31.8%) as non-white. On the basis of WHO definitions, the agestandardized prevalence was 1.78% for bilateral blindness, 2.16% for bilateral visual impairment, and 3.14% for unilateral blindness. Another 0.17% of bilateral blindness and 3.15% of visual impairment were correctable with refraction. Cataract was the principal cause of best-corrected bilateral blindness (45.4%) and bilateral visual impairment (55.5%). Other major causes of bilateral blindness were: retina/macula abnormalities including uveitis (31.8%), glaucoma (18.2%), and diabetic retinopathy (4.5%). Other major causes for visual impairment were: retina/macula abnormalities - including uveitis (22.2%), and diabetic retinopathy (3.7%). The main causes for unilateral blindness were: trauma (35.1%), and cataract (21.6%). Conclusions: This is first population-based study from Brazil to report the rates of best-corrected bilateral blindness, visual impairment, and unilateral blindness. Predominant causes of blindness and visual impairment are treatable. Commercial Relationships: Lisandro Sakata, Alcon (C), Allergan (C), Merck (C); Viviane M. Sakata, None; Ana L. Rocha, None; Gustavo Sakuno, None; Andre Mozena, None; Patricia Watanabi, None; Thais Nakayama, None; Mario Sato, None; Ana Tereza R. Moreira, None; Kenji Sakata, None Program Number: 6081 Poster Board Number: A0208 Prevalence of visual impairment in elderly Europeans: geographical and temporal trends Cecile DelCourt. Universite Bordeaux Segalen, INSERM, Bordeaux, France. Purpose: To estimate the prevalence of visual impairment in elderly Europeans, as a function of geographical area and time period. Methods: The E3 consortium comprises 15 population-based studies, performed in 10 European countries from 1991 to The study population includes 103,677 participants, 55 years or older, with visual acuity measurements. Following WHO guidelines, visual

2 impairment was classified as presenting visual acuity <20/60. Nonrefractive visual impairment was classified as best-corrected visual acuity <20/60. European countries were stratified into three areas, i.e., Northern, Western and Southern Europe, according to the United Nations geoscheme. Early and late time periods were separated by the median (year 2006). Each study provided numbers of subjects affected by visual impairment, according to gender and 5-year age groups. Random-effect meta-analysis models were performed to estimate prevalence rates across studies. Age-standardized prevalence rates were obtained in two steps: firstly, prevalence rates were estimated in each age group, and secondly, an age-standardization was performed according to the European Standard Population Results: 9 studies had data on presenting visual acuity (76,141 subjects) and 13 studies on best-corrected visual acuity (57,508 subjects). Prevalence of the two visual impairment endpoints did not vary significantly by geographical area. By contrast, both visual impairment endpoints decreased over time. Age-standardized prevalence rates of presenting visual impairment decreased from 4.88 % (95 % confidence interval (CI): ) before 2006 to 2.27 % (95 % CI: ) after Similarly, the prevalence of non-refractive visual impairment decreased from 2.21 % (95 % CI: ) before 2006 to 0.74 % (95 % CI: ) after Conclusions: The prevalence of visual impairment in elderly Europeans has decreased in recent years. This may be partly due to increased availability of cataract surgery and treatments for agerelated macular degeneration. Uncorrected refractive errors remain responsible for more than half of the cases of visual impairment. Commercial Relationships: Cecile DelCourt, Bausch+Lomb (C), Laboratoires Th a (C), Laboratoires Th a (F), Novartis (C) Program Number: 6082 Poster Board Number: A0209 Vision Impairment among Older Adults Residing in Federally Subsidized Senior Housing Communities Amanda Elliott 1, Gerald McGwin 2, 3, Cynthia Owsley 2. 1 Nursing, University of South Florida, Tampa, FL; 2 Ophthalmology, University of Alabama at Birmingham, Birmingham, AL; 3 Epidemiology, University of Alabama at Birmingham, Birmingham, AL. Purpose: To examine the rate of vision impairment and the relationship between vision impairment, cognitive impairment and chronic co-morbid conditions in residents of federally subsidized senior housing communities. Residents in these communities have low income and very limited financial resources. We hypothesized that their vision impairment rate would be higher than that of community dwelling older adults in the general population, and that cognitive status and the presence of co-morbid conditions may contribute to these rates of vision impairment. Methods: Vision screening events were held at 14 federally subsidized senior housing communities in Jefferson County, Alabama for residents 60 years of age. Habitual (walk-in) visual function (distance acuity, near acuity, contrast sensitivity), cognitive status, and self-reported chronic co-morbid medical conditions were assessed. Results: A total of 238 residents participated in the vision screenings. The vast majority (75%) of the sample was African American. Vision impairment was common, with 40% of participants having worse than 20/40 distance acuity in at least one eye and 58% having worse than 20/40 near acuity in at least one eye. Additionally, 65% failed the contrast sensitivity screening (Pelli-Robson contrast sensitivity < 1.50 in at least one eye). A total of 31% of seniors had cognitive impairment (Mini-mental state exam scores < 24). Regarding comorbid medical conditions, 31% had circulation problems, 39% had diabetes, 41% had heart problems, and 76% had hypertension (59% had two or more of these). Visual acuity was worse in those with worse cognition. Persons with heart and circulation problems also had worse vision. Multiple regression analyses found that MMSE score and heart problems significantly increase the likelihood of having vision impairment. Conclusions: This study provides visual status information about a socioeconomically disadvantaged segment of the older adult population in the U.S. Vision impairment was common. Cognitive impairment and co-morbid chronic conditions accounted for a small to moderate percentage of the variance in distance vision, near vision and contrast sensitivity. Commercial Relationships: Amanda Elliott, None; Gerald McGwin, None; Cynthia Owsley, None Support: This work was supported by The Lucille Beeson Trust; Prevent Blindness America; the EyeSight Foundation of Alabama; and Research to Prevent Blindness Inc. Program Number: 6083 Poster Board Number: A0210 Vision Impairment and Blindness due to Age-Related and other Macular Degenerations Globally: A Systematic Review and Meta- Analysis Jill Keeffe 1, Jost B. Jonas 2, Rupert Bourne 3, Tien Y. Wong 8, Janet L. Leasher 5, Kovin S. Naidoo 6, Holly Price 7, Seth R. Flaxman 4, Serge Resnikoff 9, Hugh R. Taylor L V Prasad Eye Institute, Hyderabad, India; 2 Ophthalmology, University of Heidelberg, Mannheim, Germany; 3 Vision and Eye Research Unit, Anglia Ruskin University, Cambrodge, United Kingdom; 4 School of Computer Science and Heinz College, Carnegie Mellon University, Pittsburgh, PA; 5 Nova Southeastern University, Fort Lauderdale, FL; 6 African Vision Research Institute, University of Kwazulu Natal, Durban, South Africa; 7 Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom; 8 Singapore Eye Research Institute, Singapore, Singapore; 9 Brien Holden Vision Institute, Sydney, NSW, Australia; 10 Melbourne School of Population and International Health, University of Melbourne, Melbourne, VIC, Australia. Purpose: To estimate the prevalence and number of people vision impaired or blind due to age-related (AMD) and other macular degenerations (MD) Methods: Based on the Global Burden of Disease Study 2010 and an ongoing literature search, we estimated how many people were affected by moderate and severe vision impairment (MSVI; presenting visual acuity <6/18, 3/60) and blindness (presenting visual acuity <3/60) due to MD. Change between 1990 and 2010 was calculated. Results: In 2010, out of a total of 32.4 million blind and 191 million vision impaired, 2.1 million (95% uncertainty intervals (UI): 1.9, 2.7) people were blind, and 6.0 million (UI: 5.2, 8.1) million were visually impaired due to macular degeneration. MD caused worldwide 6.6% (UI: 6.0, 7.9) of all blindness in 2010 and 3.1% (UI: 2.7, 4.0) of all MSVI. These proportions were lower in regions with younger populations (<3% in South Asia) than in high-income regions with relatively old populations (>15%). From 1990 to 2010, the number of people blind or MSVI due to MD increased by 0.6 million people (UI: 0.5, 0.8) or 36% and by 2.7 million (UI: 2.6, 3.9) people or 81%, respectively. Age-standardized global prevalence of MD related blindness in adults aged 50+ years decreased from 0.2% (UI: 0.2, 0.2) in 1990 to 0.1% (UI: 0.1, 0.2) in 2010, and MSVI remained unchanged at 0.4% (UI: 0.3,0.5 in 1990 and UI: 0.4, 0.6 in 2010). The percentage of global blindness and MSVI caused by MD increased from 4.9% (UI: 4.4, 5.8) to 6.6%, and from 1.9% (UI: 1.6, 2.4) to 3.1%, respectively. This increase took place in most world regions, except Western Europe and high-income North America with stable

3 figures. MD caused 7.3% (UI: 6.4, 8.9%) of blindness among women vs. 5.5% (UI: 4.8, 6.8%) of blindness among men. One out 15 people are blind and one out of 32 people with MSVI have vision loss due to MD. Conclusions: In 2010 the prevalence of blindness was lower and MSVI stable compared to rates in 1990 but the numbers of people were higher with increases of 36% and 81% for blindness and MSVI respectively. The lower or stable prevalence of MD blindness and MSVI may be due to the therapeutic success of intra-vitreal medications whilst the higher numbers due to the increase in life expectancy over the period. The percentage of blindness and MSVI from MD was higher in high-income regions with relatively older populations. Commercial Relationships: Jill Keeffe, None; Jost B. Jonas, None; Rupert Bourne, None; Tien Y. Wong, None; Janet L. Leasher, None; Kovin S. Naidoo, None; Holly Price, None; Seth R. Flaxman, None; Serge Resnikoff, None; Hugh R. Taylor, None Support: Bill & Melinda Gates Foundation, Fight for Sight, Fred Hollows Foundation and the Brien Holden Vision Institute Program Number: 6084 Poster Board Number: A0211 Prevalence of Visual Impairment and Blindness in Chinese American Adults: The Chinese-American Eye Study Chunyi Hsu 1, Jeniffer S. Kim 2, Shaung Wu 1, Mina Torres 1, Roberta McKean-Cowdin 2, Stanley P. Azen 2, Rohit Varma 1. 1 University of Illinois at Chicago, Los Angeles, CA; 2 University of Southern California, Los Angeles, CA. Purpose: To determine the age- and gender- specific prevalence of visual impairment and blindness in Chinese-Americans 50 years and older. Methods: A total of 4582 participants underwent ophthalmologic exams at the local clinic site with complete measurements for presenting and best-corrected distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study charts. Age- and gender- specific prevalence of visual impairment and blindness were calculated using chi-square procedures. Results: The overall prevalence of visual Impairment for presenting binocular (VA or worse, including 20/40) was 10.4%. The overall prevalence for visual impairment (best-corrected VA of 20/40 in the better eye) was 4.1% (n=186); ranging from 0.8% (50-59 years) to 25.8% ( 80 years). Visual impairment increased with age (p-trend<0.0001). The overall prevalence of blindness (best-corrected VA of 20/200 in the better eye) was 0.2% (n=10). Blindness increased with older age in the better seeing eye from years to years and in the worse seeing eye across all age ranges (p-trend<0.01). Conclusions: Rates of visual impairment and blindness are high in older participants. When comparing our results with other Chinese eye studies, rates of visual impairment and blindness vary from country to country within the Chinese population. When comparing our results with other eye studies in the United States, rates of visual impairment in CHES is similar to the rates in The Los Angeles Latino Eye Study and The Beaver Dam Eye Study. Commercial Relationships: Chunyi Hsu, None; Jeniffer S. Kim, None; Shaung Wu, None; Mina Torres, None; Roberta McKean- Cowdin, None; Stanley P. Azen, None; Rohit Varma, None Support: NIH Grant EY and Research to Prevent Blindness, NY Program Number: 6085 Poster Board Number: A0212 Prevalence and causes of vision loss in Sub-Saharan Africa: Kovin S. Naidoo 1, 2, Stephen Gichuhi 3, María-Gloria Basáñez 4, Seth R. Flaxman 5, Jost B. Jonas 6, Jill Keeffe 7, Janet L. Leasher 8, Konrad Pesudovs 9, Holly Price 10, Jennifer L. Smith Global Programs, Brien Holden Vision Institute, Durban, South Africa; 2 Research, African Vision Research Institute, Durban, South Africa; 3 Ophthalmology, University of Nairobi, Nairobi, Kenya; 4 Infectious disease epidemiology, School of Public Health, London, United Kingdom; 5 School of Computer Science & Heinz College, Pittsburg, PA; 6 Ophthalmology, Universitätsmedizin, Mannheim, Manheim, Germany; 7 Ophthalmology, University of Melbourne, Melbourne, VIC, Australia; 8 Optometry, Nova Southeastern University, Fort Laudedale, FL; 9 NHMRC Centre for Clinical Eye Research, Adelaide, SA, Australia; 10 Vision & Eye Research Unit, Anglia University, Cambridge, United Kingdom; 11 London School of Hygiene & Tropical Medicine, London, Uganda. Purpose: To estimate the magnitude, temporal trends and subregional variation in the prevalence of blindness and moderate/severe vision impairment (MSVI) in Sub-Saharan Africa. Methods: A systematic review was conducted of published and unpublished population-based surveys as part of the Global Burden of Disease, Risk Factors and Injuries Study The prevalence of blindness and vision impairment by country and subregion was estimated. Results: In Sub-Saharan Africa, 52 studies satisfied the inclusion criteria. The estimated age-standardised prevalence of blindness decreased by 32% from 1.9% (95% confidence interval (CI): ) in 1990 to 1.3% (95%CI: ) in 2010 and MSVI by 25% from 5.3% (95%CI: ) to 4.0% (95%CI: ) over that time. However, there was a 16% increase in the absolute numbers with blindness and a 28% increase in those with MSVI. The major causes of blindness in 2010 were; cataract 35%, other/unidentified causes 33.1%, refractive error 13.2%, macular degeneration 6.3%, trachoma 5.2%, glaucoma 4.4% and diabetic retinopathy 2.8%. In 2010, agestandardized prevalence of MSVI in Africa was 3.8% (95%CI: ) for men and 4.2% (95%CI: ) for women with sub-regional variations from 4.1% (95%CI: ) in West Africa to 2.0% (95%CI: ) in Southern Africa for men; and 4.7% (95%CI: ) in West Africa to 2.3% (95%CI: ) in Southern Africa for women. Conclusions: The age-standardised prevalence of blindness and MSVI decreased substantially from 1990 to 2010, although there was a moderate increase in the absolute numbers with blindness or MSVI. Significant sub-regional and gender disparities exist. Commercial Relationships: Kovin S. Naidoo, None; Stephen Gichuhi, None; María-Gloria Basáñez, None; Seth R. Flaxman, None; Jost B. Jonas, None; Jill Keeffe, None; Janet L. Leasher, None; Konrad Pesudovs, None; Holly Price, None; Jennifer L. Smith, None

4 Program Number: 6086 Poster Board Number: A0213 Is optic neuritis incidence rising? Evidences from an epidemiological study in Barcelona, Spain Elena H. Martinez-Lapiscina 1, Elena Fraga-Pumar 1, Xabier Pastor 2, Monica Gómez 3, Artur Conesa 2, Raimundo Lozano-Rubí 2, Bernardo Sanchez-Dalmau 1, 4, Alvaro Alonso 5, Pablo Villoslada 1. 1 Neurology, IDIBAPS-Hospital Clinic of Barcelona, Barcelona, Spain; 2 Department of Medical Informatics, Hospital Clinic of Barcelona- University of Barcelona, Barcelona, Spain; 3 Direction of Strategy and Planning, Hospital Clinic of Barcelona and Technical Office AISBE, Barcelona, Spain; 4 Ophthalmology, IDIBAPS- Hospital Clinic of Barcelona, Barcelona, Spain; 5 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. Purpose: Incidence of Optic neuritis (ON) ranges between cases per 100,000 person-years. However, epidemiology of ON has not been updated and there are suggestions that incidence is rising. Considering new therapies for ON, it is important to update epidemiology to design clinical trials and improve health management of ON. We aim to provide prevalence and incidence rates of ON in Barcelona, Spain from 2008 to Methods: Retrospective evaluation of hospital electronic records matching following ICD-9-CM codes: optic neuritis, optic neuritis, unspecific, optic papillitis, retrobulbar neuritis, acute, other optic neuritis and optic neuropathy search-terms. Demographic and clinical data were collected from records with confirmed diagnosis of demyelinating ON, including idiopathic, Multiple Sclerosis and Neuromyelitis Optica origin. Results: Prevalence of acute optic neuritis on 31, December 2012 was 2.75 cases per 100,000 people. Mean annual prevalence of acute ON during periods was 7.87 cases per 100,000 personyears (figure 1A). Mean annual incidence was 5.36 cases per 100,000 person-years (figure 1B). ON recovery was defined as good (high contrast VA > 20/25) for 81% of patients after 12 months of follow up but 4 (5%) patients had VA less than 20/400 which is the VA considered by WHO as blindness criteria. Cumulative probability for MS progression was nearly 30% by 6 months and 45% by the end of follow-up (5 years) (figure 2). Conclusions: Incidence of ON in Barcelona during was higher than previously reported. It may be explained by evolution of diagnosis criteria, use of referral-center approach instead of population-based approach, increased awareness of demyelinating diseases and by possible true increase in its incidence. Commercial Relationships: Elena H. Martinez-Lapiscina, Teva (R); Elena Fraga-Pumar, None; Xabier Pastor, None; Monica Gómez, None; Artur Conesa, None; Raimundo Lozano-Rubí, None; Bernardo Sanchez-Dalmau, Novartis (R); Alvaro Alonso, None; Pablo Villoslada, is He is a shareholder in Bionure Farm (I), Roche, Novartis, MedImmune, TFS, Heidelberg Engineering and Neurotec Farma (R) Program Number: 6087 Poster Board Number: A0214 PREVALENCE OF NEAR VISION IMPAIRMENT IN MIDDLE-AGED AND OLDER ADULTS IN AN URBAN CENSUS SECTOR OF PARINTINS, BRAZILIAN AMAZON REGION Solange R. Salomao 1, Sergio Munoz 2, Joao M. Furtado 1, 3, Paula Y. Sacai 1, Marcos J. Cohen 4, Jacob M. Cohen 5, 4, Marcia R. Mitsuhiro 1, Sigrid B. Arruda 4, Rubens Belfort, Jr. 1, Adriana Berezovsky 1. 1 Departamento de Oftalmologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; 2 Salud Publica, Universidad de La Frontera, Temuco, Chile; 3 Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeca e Pescoco, Faculdade de Medicina de Ribeirao Preto, USP, Ribeirao Preto, Brazil; 4 Instituto de Olhos de Manaus, Manaus, Brazil; 5 Cirurgia, Divisao de Oftalmologia, Faculdade de Medicina - Universidade Federal do Amazonas, Manaus, Brazil.

5 Purpose: To estimate the prevalence of near vision impairment and use of correctable spectacles in older adults in an urban census sector of Parintins, Brazil. Methods: An urban census sector was conveniently chosen for its proximity to the eye clinic for ophthalmic assessment. Subjects were enumerated through a door-to-door survey and those with ages 45 years and older were invited for ophthalmic assessment. Uncorrected, presenting and best-corrected near visual acuity was measured in each eye at 40 cm using a logmar near vision tumbling E chart followed by an ocular examination. Additional lenses were tested for near in those with uncorrected near visual acuity <20/40. Presbyopia was considered as the main cause of near vision impairment when uncorrected near vision was <20/40 improving to best-corrected near vision of >20/32. Results: A total of 178 eligible persons in 136 households were enumerated, and 144 (80.9%) examined. The prevalence of uncorrected near visual acuity impairment (<20/40 in the better eye) was 88.1% (95% confidence interval [CI]: 82.7% %), and 18.2% (95% CI: 11.8% %) with best correction. Uncorrected near vision impairment was statistically independent of age, gender and educational level. Presbyopia as main cause of near vision impairment was found in 79.37% (95% CI: 72.2% %) and it was reduced in those aged 70 years and older, when other ocular pathologies become more prevalent (p<0.001). The odds of having presbyopia as main cause of near vision impairment in subjects with superior educational level was 18 times greater than those having less than complete primary education (p<0.001). For those in need of near refractive correction 48% did not have the necessary spectacles and 9% were wearing inadequate correction. Conclusions: In a small urban area of the Brazilian Amazon region, the prevalence of near vision impairment in middle-aged and older adults was almost 90% with most of it correctable optically. Higher educational level seems to be a risk factor for presbyopia in this population. More than half of those in need of near glasses were not wearing them, reinforcing the need of access to refractive services in that region. Commercial Relationships: Solange R. Salomao, None; Sergio Munoz, None; Joao M. Furtado, None; Paula Y. Sacai, None; Marcos J. Cohen, None; Jacob M. Cohen, None; Marcia R. Mitsuhiro, None; Sigrid B. Arruda, None; Rubens Belfort, Jr., None; Adriana Berezovsky, None Support: Conselho Nacional de Pesquisa e Desenvolvimento Tecnológico, CNPq, Brasilia, Brasil, Programa Ciência sem Fronteiras grant to SRS, scholarship to SM and post-doctoral scholarship to JMF; Lions Club International Foundation, Sight First Grant to SRS study was to examine the diffusion of this treatment in the Portuguese National Health System. Methods: We used a database of all in-patient and day cases stays from all Portuguese public hospitals during period We selected cases based on four procedures, ICD-9-CM codes: 1414, 1475, 1479, 149. Given that these procedures are not specific for intravitreal injections it is likely that our results captured cases that are not anti-vegf injections. Because we were only interested in the diffusion of new anti-vegf treatments we included years as baseline because during that period drugs anti-vegf were not licenced. We calculated absolute values, yearly rates of episodes and rates of patients treated per 100,000 habitants. Results: Our final sample included 98,408 episodes, 52% performed in men. The total number of episodes increased from 1,815 in 2002 to 25,106 in 2012 (mean annual increase of 32%). These values corresponded to an increase in ratios per 100,000 from 17.4 to The highest increase was observed between 2007 and 2009 with an increase of 337%. The number of treated patients was six times higher in 2012 with 11,937 treated compared with 1,561 in 2002 (mean annual increase of 24%). The highest increase was also observed between 2006 and In 2012, 86.2% of the procedures were performed as day cases, representing an increase of 78.3% as compared to The percentage of patients older than 60 years increased from 60% in 2002 to 80% in Five diagnoses (See Figure: wet AMD, diabetic macular oedema, oedema of the retina, retinal neovascularization and non-specific AMD) were associated with 73% of these procedures in 2012, in contrast with only 16% in Conclusions: The number of procedures grew exponentially since anti-vgef treatments were approved. The aging of the population and the expected growth in conditions such as diabetes and AMD are likely to increase the demand for these procedures in years to come. These factors are likely to impose tremendous challenges to health services. That will happen not only due to the price of the procedures but also for number of physicians and other staff needed in Ophthalmology departments. Program Number: 6088 Poster Board Number: A0215 Emergence of intravitreal injections in a National Health System: ANA P. MARQUES 1, Antonio F. Macedo 2, Amandio A. Rocha-Sousa 3, Julian Perelman 4, António M. Baptista 2, Rui Santana 1. 1 Policy Management and Health Administration, National School of Public Health; Nova University, Lisboa, Portugal; 2 Centre/Department of Physics and Optometry, Minho University, Braga, Portugal; 3 Department of Senses Organs, Faculty of Medicine; University of Porto, Porto, Portugal; 4 Health Economics, National School of Public Health; Nova University, Lisboa, Portugal. Purpose: Intravitreal injections of antivascular endothelial growth factor (anti-vegf) are an innovative procedure with well-proven benefits to preserve vision in certain eye conditions. The aim of this

6 Purpose: An economic evaluation was conducted to determine the incremental cost-utility ratio of intravitreal aflibercept compared with ranibizumab for the treatment of macular edema (ME) secondary to central retinal vein occlusion (CRVO) over a lifetime horizon from the perspective of a Canadian publicly funded healthcare system. Methods: The Markov model consisted of six health states based on the Early Treatment of Diabetic Retinopathy Study chart: no vision impairment ( 80 letters); mild vision impairment (79-65 letters); moderate vision impairment (64-50 letters); severe vision impairment (49-35 letters); total blindness (best corrected visual acuity counting fingers or worse); and death. Transitions between health states were captured in a transition probability matrix reflecting the proportions of patients moving between each health state according to the COPERNICUS and CRUISE trial data. Three different time periods were modeled: monthly treatment (0 24 weeks), PRN treatment (24 52 weeks) and long-term disease progression (52 weeks onwards). Direct medical costs for the visual acuity health states were based on data from a 2008 multi-country survey of patients with visual impairment. Costs and outcomes occurring after 12 months were discounted at a rate of 5% per annum. Results: Deterministic analyses show that treatment with intravitreal aflibercept provides 7.33 quality-adjusted life years (QALYs) at a cost of CDN$89,377 while treatment with ranibizumab resulted in 7.08 QALYs at a cost of CDN$95,006. The majority of 1,000 probabilistic modeling simulations indicate that treatment with intravitreal aflibercept is effective and less costly than ranibizumab. Cost-effectiveness acceptability curves demonstrated that the probability of intravitreal aflibercept being cost-effective at any willingness-to-pay threshold between CDN$0 and CDN$100,000 is greater than 90%. All sensitivity analyses reveal that intravitreal aflibercept dominated ranibizumab. Conclusions: Intravitreal aflibercept is an effective and well tolerated option for the treatment of ME secondary to CRVO, and is costeffective compared with ranibizumab. Commercial Relationships: Alan F. Cruess, Alcon (R), Bayer (R), Novartis (R); Mark Jeddi, Bayer (E); Ron Goeree, None; Gord Blackhouse, None; Marianne Eriksson, Bayer (E) Commercial Relationships: ANA P. MARQUES, None; Antonio F. Macedo, None; Amandio A. Rocha-Sousa, None; Julian Perelman, None; António M. Baptista, None; Rui Santana, None Support: FCT grant PTDC/DPT-EPI/0412/2012 Program Number: 6089 Poster Board Number: A0216 Incremental Cost-Utility Ratio of Intravitreal Aflibercept Compared with Ranibizumab for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion Alan F. Cruess 4, Mark Jeddi 1, Ron Goeree 2, Gord Blackhouse 2, Marianne Eriksson 3. 1 Bayer, Toronto, ON, Canada; 2 Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; 3 Bayer AB, Solna, Sweden; 4 Ophthalmology, Dalhousie University, Halifax, NS, Canada. Program Number: 6090 Poster Board Number: A0217 Loaner ophthalmoscopes in conjunction with simulation and clinical training improve fundoscopy skills of third year medical students Jennifer Park 1, Russell M. Levine 1, Lewis A. Eisen 3, Umar Mian 2, Manuela Calvo 4, Amanda C. Raff 4, Mimoza Meholli 5, William B. Burton 6, Jamie B. Rosenberg 2. 1 Albert Einstein College of Medicine, Bronx, NY; 2 Ophthalmology and Visual Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; 3 Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; 4 Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; 5 Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, NY; 6 Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY. Purpose: To improve medical students confidence and ability in using an ophthalmoscope through simulation training and increased access to ophthalmoscopes on an inpatient medicine floor Methods: Third-year medicine clerks were divided into three groups: Group A participated in simulation training with clinical practice and were also loaned Optyse lens-free ophthalmoscopes (Ophthalmos, Cambridge, UK) to use during the clerkship; Group B participated in training and practice only; Group C received the Optyse only. All were instructed to examine their patients eyes. At the end of

7 the rotation, students completed a survey and were tested with a standard direct ophthalmoscope (Welch Allyn, Skaneateles Falls, NY) to identify a letter superimposed on the optic nerve of a simulator (Kyoto Kagaku, Kyoto, Japan), using the large and small pupil settings. Results: Sixty-six students participated. Group A had 19 students; Group B, 15; Group C, 32. Three students in Group A (15.8%), 1 in Group B (6.7%), and 6 in Group C (18.8%) owned their own ophthalmoscopes. Of all students who had simulation and clinical training, those who were loaned an Optyse were more likely to agree or strongly agree with these statements: I am likely to use an ophthalmoscope in the future (94.7% vs. 60.0%, p=0.03); Fundoscopy is a standard part of the physical exam (79.0% vs. 33.3%, p=0.01). Among students who received loaner ophthalmoscopes, those who also received simulation and clinical sessions agreed or strongly agreed that they were comfortable using an ophthalmoscope (68.4% vs. 31.3%, p=0.02), confident in visualizing the optic nerve (73.7% vs. 28.1%, p=0.003), and likely to use an ophthalmoscope in the future (94.7% vs. 68.8%, p=0.04). Those who received the loan performed significantly more fundoscopic exams (Group A, 3.6 patients; Group C, 2.6 patients vs. Group B, 0.1 patients, p=0.01). Students who received both the Optyse plus simulation and clinical training scored better on the test than those who received the Optyse without undergoing training (large pupil, 100% vs. 78.1%, p=0.04). Conclusions: Simulation training, clinical practice, and the provision of a free ophthalmoscope loan increase students agreement that fundoscopy is a standard part of the physical exam, likelihood of performing fundoscopy, and confidence and ability in performing a fundoscopic exam. Student examining simulator Commercial Relationships: Jennifer Park, None; Russell M. Levine, None; Lewis A. Eisen, None; Umar Mian, None; Manuela Calvo, None; Amanda C. Raff, None; Mimoza Meholli, None; William B. Burton, None; Jamie B. Rosenberg, None Support: Bronx Lions Club Grant, Research to Prevent Blindness Foundation unrestricted institutional grant award, Albert Einstein College of Medicine Grant for Excellence in Medical Education Program Number: 6091 Poster Board Number: A0218 A Glimpse into the Resident s Perspective: Current attitudes and future outlook Saba Al-Hashimi, Rachel Song, Manishi Desai. Boston Medical Center, Boston, MA. Purpose: The purpose of this study is two-fold. The first is to assess the current attitude residents have on the future outlook of ophthalmology and their level of satisfaction. The second is to determine whether their outlook differs depending on the current level of training or the program s ranking according to the most recent edition of U.S News Top 10 Hospitals. Methods: A link to an anonymous survey was ed to residents at 12 different institutions across the nation. Future outlook was determined by: 1) using a scale of 1-10 with 1 being not at all optimistic and 10 being extremely optimistic about future job satisfaction 2) asking whether residents felt they would be fairly compensated (yes/no). Current level of satisfaction was examined by asking if residents would apply to medical school and/or ophthalmology residency again. A two-tailed t-test was used to calculate statistical significance. Results: Of the 184 residents invited to participate, 27.7% responded (20 first year, 20 second year and 11 third year residents). Residents reported a mean score of 7.2 in regards to level of optimism of future job satisfaction. First year residents averaged a score of 6.75, 16/20 would apply for ophthalmology residency again and 10 would apply to medical school again. Second year residents averaged a score of 7.15, 16/20 would apply for residency again and 16 would apply to medical school again. Third year residents averaged a score of 8.09, 11/11 would apply for residency again and 9 would apply to medical school again. Of the 51 responses, 17 reported coming from a program ranked as top 10. Optimism for future job satisfaction on average was 8.12 for residents from top 10 programs compared to 6.70 for all others. 81.8% would apply to ophthalmology again compared to 88.2% from top ten programs, 29.4% would not apply again to medical school versus 30.3% from top ten programs. A statistically significant difference (p-value <0.02) was found in regards to optimism about future job satisfaction between residents training at a top ten program versus a non-top ten program. Conclusions: The survey suggests that most residents would choose ophthalmology again but nearly half felt that they will not be fairly compensated and almost a third would not choose to do medical school again. Optimism about future job satisfaction was highest for third year residents and significantly higher for residents from top 10 programs. Commercial Relationships: Saba Al-Hashimi, None; Rachel Song, None; Manishi Desai, None Program Number: 6092 Poster Board Number: A0219 Measurable Indicators of Eye Care Integration into Health Systems in the Western Pacific Helen Chan 1, 2, Andreas Mueller 1. 1 Western Pacific Regional Office, World Health Organisation, Manila, Philippines; 2 Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia. Purpose: WHO s new global action plan Towards Universal Eye Health recommends better integration of eye health within health systems. Key measurable indicators include the number of Member States which include eye care sections in their national lists of essential medicines and include eye health into national health plans.our purpose was to assess the current state of integration of eye care into health plans and policies in the 28 low- and middle-income Western Pacific Region (WPR) Member States. Methods: Systematic qualitative review of key documents including: National health plans and strategic frameworks of ministries of health National minimum packages of care Essential drug and equipment lists

8 Results: 23 WPR states had National Health Plans accessible electronically via internet search, ministry of health and WHO databases, or through contact persons in country offices. Of these, 12 Plans (52%) made at least one reference to eye care. Only one of 23 Plans (4%) was linked to a Vision 2020 National Plan (Mongolia).3 WPR states had National Minimum Packages of Care accessible. Of these, only 1 Package (Cambodia) was inclusive of eye care, specifically the management of refractive error, active trachoma and cataract.15 National Drug Lists were available and evaluated for the inclusion of basic eye medications as per Vision 2020 Technology Guidelines (2006). Of these 15 lists, only 3 (20%) listed all four of the basic medications (Solomon Islands, Tonga & Vanuatu). No National Equipment Lists were identified from WPR states. Conclusions: This study forms the first summary of currently available information on the integration of eye care into health planning in low- and middle-income WPR states. The major limitation is incompleteness of data, which highlights the need for development of a central database. Only 52% of National Health Plans made specific reference to eye care and only 4% of Plans were linked to a Vision 2020 Plan. Eye care may be better formally integrated into health systems at a national level if it is more specifically included in National Health Plans. Eye care integration into primary care may be improved if the necessary medications and equipments are available at the point of primary care provision. Assuming policies and plans have sufficient reach, one first step is to include basic eye medicines on National Essential Drug Lists. Commercial Relationships: Helen Chan, None; Andreas Mueller, None Program Number: 6093 Poster Board Number: A0220 Vision, Older Drivers & Public Safety: Can An Annual Eye Examination Requirement Reduce Motor Vehicle Collision In a Cost Effective Way? Lori L. Grover 1, Chuck Shih 2. 1 Health Solutions, Arizona State Univ, CONHI Ctr Translational Health Science, Phoenix, AZ; 2 School of Public Health & Health Services, George Washington University, Washington, DC. Purpose: Driving is the preferred means of travel among U.S. older adults who comprise the fastest growing cohort of drivers based on number and miles driven per year. As this population ages, evidencebased safety policies will become more important. A key question remains in how to translate evidence into best practices. Although licensure policies nationwide include vision-related thresholds, consensus does not exist on what constitutes visual criteria and risk factors for improved driver safety. We investigated the impact of an annual eye exam for all older US drivers on reducing motor vehicle collision (MVC) mortality and morbidity. Methods: We identified emerging evidence from the literature and an older driver triad serving as the nexus of clinical care, evidence and licensure regulations. We conducted a cost-effectiveness analysis (CEA) to understand the economic impact of the potential intervention modeled on available data employing a one year time horizon and three model alternatives. Results: The assumption that vision impairment equates to poor driving is not supported by evidence. Analysis revealed an implementation cost of intervention approaches $6.8 billion and involves 27 million older drivers. Requiring an annual eye exam reduces the number of MVCs and resulting injury/fatalities by approximately 10%; however, improvements in safety come at high cost. Evidence gaps required simplifying assumptions to be made than what would ultimately be desired. A need exists for the scientific community to further develop evidence that informs driving policies, care sequences, and factors like burden on older drivers and stakeholders. Conclusions: In combination with the mixed body of evidence on MVC risk in the older driver with VI population, current licensure policies employed in the U.S. that rely primarily on VA status may not target older drivers with the greatest MVC risk. Additional research is needed to identify vision-related licensure policies that effectively reduce MVC and fatality risk and can be incorporated into public health recommendations, and evidence is needed to better refine the CEA model to assist with our understanding of MVC risk in the older driver population. Commercial Relationships: Lori L. Grover, None; Chuck Shih, None Program Number: 6094 Poster Board Number: A0221 Improving Eye Care Follow-Up Adherence in Patients with Diabetes: The Effectiveness of Patient Contracts in a Community-Based Eye Screening Chelsea L. Aleo 1, Ann P. Murchison 1, Lisa A. Hark 1, Yang Dai 1, Eileen Mayro 1, Benjamin Leiby 2, Laura Pizzi 2, Julia A. Haller 1. 1 Research, Wills Eye Hospital, Philadelphia, PA; 2 Thomas Jefferson University, Philadelphia, PA. Purpose: Patient contracts are increasingly utilized in medical practice and have the potential to improve health outcomes in highrisk populations. However, as a relatively new tool, there has been limited research regarding the efficacy of patient contracts. Diabetic retinopathy (DR) is one of the leading causes of vision impairment in US adults and only 50-60% of adults with diabetes adhere to annual dilated fundus exam recommendations. This study aimed to evaluate the impact of patient contracts on follow-up adherence in patients with diabetes after a free, community-based eye screening. Methods: This prospective, randomized study implemented a noninvasive, non-mydriatic fundus camera in an urban, communitybased pharmacy setting to screen for DR and other ocular diseases in patients with diabetes. Patients were randomized into a contract or non-contract group. Patients who signed a contract agreed to: 1) review their results with their primary care doctor, 2) follow-up with an ophthalmologist, and 3) inform research staff if/when they completed an eye appointment. All study participants and their primary care doctors were notified of their results via mail. Followup questionnaires were administered to all patients by telephone 3 months after the screening results were mailed. Results: Five hundred patients were screened and 113 (22.6%) had abnormal results. The majority of patients were African American (69.2%) and female (56.6%). The mean age was 55.2 years. Of the patients who had abnormal results, 34 (30.1%) adhered to follow-up recommendations. There was no significant difference in follow-up adherence between the contract (28.6%) and non-contract group (31.0%) (p=0.59). In addition, 70.4% of patients did not comply with at least one measure of the contract agreement. Conclusions: Contracts did not increase follow-up adherence to eye appointments in patients with diabetes. The majority of patients did not comply with their contract and follow-up adherence was low in both groups. Most research has yielded mixed results regarding the efficacy of contracts in improving health outcomes. Therefore, different types of contracts or other patient-centered tools should be evaluated in order to increase follow-up adherence in patients at high risk for DR. Commercial Relationships: Chelsea L. Aleo, None; Ann P. Murchison, None; Lisa A. Hark, None; Yang Dai, None; Eileen Mayro, None; Benjamin Leiby, None; Laura Pizzi, None; Julia A.

9 Haller, Advanced Cell (C), Allergan (C), Merck & Co (C), Second Sight Medical Products (C), ThromboGenics (C) Support: CDC Grant 1U58DP Clinical Trial: NCT Program Number: 6095 Poster Board Number: A0222 The Effectiveness of a Tailored Intervention to Increase Follow- Up Adherence in Patients with Glaucoma Judie Tran, Michael Waisbourd, David Weiss, Ann P. Murchison, L Jay Katz, George L. Spaeth, Julia A. Haller, Lisa A. Hark. Department of Research, Wills Eye Hospital, Philadelphia, PA. Purpose: This randomized, prospective study evaluated the effectiveness of an intervention that utilized personalized reminder letters and telephone calls to increase follow-up adherence in patients with glaucoma in an urban, tertiary eye care clinic. Methods: Patients previously diagnosed with glaucoma and scheduled for a 1-month, 3-month, or 6-month follow-up appointment between September 1, 2013 and November 30, 2013 were randomized into the usual care group or the intervention group. Patients in the usual care group did not receive a reminder call or letter prior to their appointment and did not receive phone calls to reschedule if they did not attend their appointment. Patients in the intervention group received a personalized reminder letter 2 weeks before their scheduled appointment and a reminder phone call 1-2 days before their appointment. If the patient in the intervention group did not attend their appointment, they were called up to 2 times to reschedule. If these intervention patients failed to reschedule their appointment, a personalized letter was sent to their home. Follow-up adherence was recorded using electronic health records. Demographic data were also documented. Results: The final sample size included 250 patients. Male and females patients were equally represented. The majority of patients were African-American (56%), with an average age of 69 years. Preliminary results with 177 patients demonstrate that 83% of patients in the intervention group were adherent to their recommended follow-up appointment, compared to 71% in the usual care group (p = 0.078). However, this difference is only approaching statistical significance. Patients over the age of 60 were significantly more likely to adhere to their follow-up appointment regardless of intervention group (p = 0.01). Conclusions: Tailored phone calls and letters may increase followup adherence among patients with glaucoma in an urban tertiary eye care clinic. While the effectiveness of the intervention did not increase with patient age, patients over age 60 were more likely to adhere to their follow-up appointment. Therefore, future interventions to increase adherence in glaucoma patients should target younger patients. Commercial Relationships: Judie Tran, None; Michael Waisbourd, None; David Weiss, None; Ann P. Murchison, None; L Jay Katz, Aerie Pharm (C), Aerie Pharm (F), Alcon (C), Allergan (C), Allergan (F), Bausch & Lomb (C), Bausch & Lomb (F), Glaukos (C), Glaukos (I), Inotek (C), Lumenis (C), Merck (C), Merck (F), Sensimed AG (C), Sucampo (C); George L. Spaeth, None; Julia A. Haller, Advanced Cell (C), Allergan (C), Merck & Co (C), Second Sight Medical Product (C), ThromboGenics (C); Lisa A. Hark, None Support: Fund by the Pennsylvania Department of Health Clinical Trial: NCT Program Number: 6096 Poster Board Number: A0223 A Comparison of Three System-Based Interventions to Improve Follow-Up Adherence in a Primary Eye Care Setting Brianna Kenney, Lisa A. Hark, Ann P. Murchison, Robert Bailey, Julia A. Haller, Joseph A. Bilson. Wills Eye Hospital, Philadelphia, PA. Purpose: Patient adherence to recommended follow-up appointments in an urban ophthalmology clinic is often suboptimal and can impact patient outcomes. The purpose of this study was to compare three system-based interventions to improve follow-up adherence rates in patients who were recommended by an ophthalmologist to follow-up in 6 months, 1 year and 2 years. Methods: A total of 1096 patients with a 6-month, 1-year, or 2-year recommended follow-up appointment date during September 1, 2013 to November 30, 2013 were randomized into three groups: usual care, automated telephone call, and personalized telephone call. The usual care group was sent personalized reminder letters 1-month prior to their recommended appointment date. The automated telephone call group was reminded to schedule an appointment using a PAM2000 phone system 1-month before their recommended dates. The personalized telephone call group was contacted by staff 1-month before their recommended follow-up dates and given the opportunity to schedule an appointment at the time of the call. Adherence was determined using electronic health records by evaluating whether the patients scheduled and kept their appointments. Results: The majority of patients were African American (62%) and female (60%). The mean age was 57 years. Preliminary data indicates that 43% of patients across all groups scheduled an appointment. When examining scheduling rates by group, 53% of the personal telephone call group, 40% of the automated telephone group and 37% of the usual care group scheduled an appointment. Patients in the personal call group were significantly more likely to schedule an appointment compared to the two other groups (p=0.016). Automated telephone calls were not successful in significantly increasing patient adherence to recommended follow-up dates (p=0.427). Complete patient scheduling and follow-up adherence results can be found in Table 1. Conclusions: General ophthalmology clinics could consider utilizing personal telephone calls to improve recommended follow-up scheduling. Patients who were personally called were significantly more likely to make an appointment. This improvement in follow-up adherence could improve patients future outcomes as well as clinic revenue. Commercial Relationships: Brianna Kenney, None; Lisa A. Hark, None; Ann P. Murchison, None; Robert Bailey, None; Julia A. Haller, Advanced Cell (C), Allergan (C), Merck & Co (C), Second Sight Medical Products (C), ThromboGenics (C); Joseph A. Bilson, None Support: Wills Eye Innovation Grant WEF Clinical Trial: NCT

10 Program Number: 6097 Poster Board Number: A0224 Medicare Payment and Cataract Surgical Volume Dan Gong, Jun Lin, James C. Tsai. Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, CT. Purpose: The extent to which Medicare payment impacts cataract surgical volume has not been well quantified. This project studies the Medicare payment-surgical volume elasticity for complex (CPT 66982) and non-complex (CPT 66984) cataract surgeries and determines whether reduced Medicare payment shifts the composition of cataract surgery type from non-complex to complex. Methods: [i] Payment data ( ) from the Medicare Physician Fee Schedule and [ii] surgical volume data from Medicare Part B Carrier Summary Data Files were matched by Medicare Part B carriers. A fixed effects regression model was used to analyze associations between Medicare payment and cataract surgical volume, controlling for [a] stable carrier-specific characteristics causing regional variations in cataract surgical volume, [b] national trends in cataract surgical volume, and [c] national trends in cataract surgery composition including those secondary to increased alphablocker use. Shifts between procedures were based on changes in the proportion of total cataract surgeries performed that were complex. All analyses adjusted for Medicare beneficiary population and inflation. Results: From 2005 to 2009, 658,265 complex cataract surgeries at an average payment of $ (in 2005 $) and 11,593,725 noncomplex cataract surgeries at an average payment of $ (in 2005 $) were performed across 55 Medicare carriers. For every 1% decrease in Medicare payment for complex cataract surgery, surgical volume increased by 1.30% (p<0.001). For every 1% decrease in non-complex cataract surgery payment, surgical volume increased by 0.45% (p=0.03). When payment for both procedures decreased by 1%, the proportion of complex cataract surgeries increased by 0.83% (p<0.001). An ophthalmologist performing ten CPT surgeries at $800 and ninety CPT surgeries at $600 who experiences a 10% reduction in Medicare payment will recoup more than half (51.6%) of lost income from decreased payment by performing more procedures. Conclusions: Our study demonstrates that reduced Medicare payments are associated with significant increases in cataract surgical volume with greater responses seen for complex cataract surgeries. Moreover, decreased payment leads to a shifting effect from lower-paid non-complex to higher-paid complex procedures. These behavioral offsets are critical for national policymakers to understand when attempting to contain healthcare costs through payment reform. Commercial Relationships: Dan Gong, None; Jun Lin, None; James C. Tsai, None Program Number: 6098 Poster Board Number: A0225 A cost effectiveness analysis of cataract surgery Domenico Lepore 1, Federico Lucidi 1, Matteo Ruggeri 2, Gianfranco Damiani 3. 1 Deparment of Ophthalmology, Catholic University of the Sacred Heart, Rome, Italy; 2 Department of Health Economics, Catholic University of the Sacred Heart, Rome, Italy; 3 Department of Hygiene and Public Health, Catholic University of the Sacred Heart, Rome, Italy. Purpose: to compare the use of disposable vs. reusable instruments in anterior and posterior segment surgery. Efficiency, effectiveness, time and cost reduction of cataract and retina surgery were evaluated. Methods: starting from January 2012 until July 2012, 4 different eye surgeons in the Department of Ophthalmology at the Catholic University of the Sacred Heart Hospital have been monitored in 64 different operating session, both for anterior (cataract) and posterior segment (membrane peeling and retinal detachment). We record data on: timing of intervention, staff employed (with an estimation of labour costs), material and drug used and adverse events. The full cost of three different surgical procedures, cataract, epiretinal membrane peeling and vitrectomy for retinal detachment, have been calculated with individual differences among surgeons. Results: using disposable instruments all surgeons were able to perform 33% more surgical procedures than reusable surgical, both in anterior and posterior segment. Disposables allow a greater efficiency with labour cost saving and turnover time reduction. High surgeons acceptance rate was also recorded because of a significant reduction of surgical malfunctions. Conclusions: our study demonstrate tangible benefits of using disposable surgical in cataract and retinal surgery. Commercial Relationships: Domenico Lepore, None; Federico Lucidi, None; Matteo Ruggeri, None; Gianfranco Damiani, None Program Number: 6099 Poster Board Number: A0226 Patient-Reported Outcomes in Optometric Glaucoma Care Paul P. Lee 1, 2, Sanjay Asrani 2, William Rafferty 2, David Lobach 3, Carrie E. Huisingh 4, Gerald McGwin 4. 1 Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI; 2 Ophthalmology, Duke University, Durham, NC; 3 Family Medicine, Duke University, Durham, NC; 4 Ophthalmology, University of Alabama, Birmngham, AL. Purpose: To better understand the care for diagnosed glaucoma patients provided by optometrists (OD s). Since little data exist about patient reported outcomes (PRO s) among patients of OD s, we sought to characterize if and how PRO s change over time among glaucoma patients cared for by community based OD s as part of a randomized controlled trial (RCT). Methods: As part of a RCT to assess the value of patient involvement and technology based decision aids on the content of glaucoma care in the community setting, we measured NEI-VFQ, SF-12, EQ-5D, and patient satisfaction (CAHPS) through telephone interviews. Survey data was obtained from 678 patients of 66 OD s at baseline, 531 patients of 60 OD s at year 1, and 450 patients of 60 OD s at year 2. Because the randomization was at the OD level, (based on the same assignment for all participating OD s in a practice to avoid cross-contamination at a practice site), we analyzed PRO s at the level of the OD. Results: At baseline, there were no differences in SF-12 (PCS and MCS), EQ-5D, overall satisfaction on the CAHPS, or VFQcomposite or subscale scores, other than a better score on the VFQ mental health subscale in the intervention arm (mean of 73.4) compared to the control arm (70.4)(p=0.04).. At year 1, intervention arm PRO s were significantly better in the mental health component of the SF-12 (57.8 vs. 55.8, p =0.003), the VFQ ocular pain subscale (90.5 vs. 85.9, p =0.03), the VFQ mental health suscale (73.7 vs. 69.7, p=0.02), and the VFQ role limitations subscale (92.7 vs. 87.7, p=0.02). However, by year 2, there were no significant differences in PRO s. Overall, the average patient showed high levels of satisfaction throughout the study (mean of 9.4 to 9.5 on a 0-10 scale), relatively good visual function on the VFQ-composite (mean of 84 to 87), and more physical limitations on the SF-12 (PCS of 44 to 47) but less mental health limitations (MCS of 55 to 58). Conclusions: Patients who receive glaucoma care from communitybased optometrists report being highly satisfied with their care over 2 years, with relatively stable VFQ, SF-12 and EQ-5D scores. However, these PRO s need additional analysis relative to the process

11 quality of care and examination data (including visual field data) that was collected through chart abstraction as part of this study. Commercial Relationships: Paul P. Lee, None; Sanjay Asrani, None; William Rafferty, None; David Lobach, None; Carrie E. Huisingh, None; Gerald McGwin, None Support: NIH Grant EY Clinical Trial: NCT Program Number: 6100 Poster Board Number: A0227 Telemedicine versus in-person examination: High patient satisfaction with a teleglaucoma model for detection and management of glaucoma suspects in rural Alberta Sourabh Arora, Khaliq Kurji, Irfan Kherani, Christopher J. Rudnisky, Karim F. Damji. Ophthalmology, University of Alberta, Edmonton, AB, Canada. Purpose: To assess patient satisfaction with a teleophthalmology model for glaucoma detection and management as compared to standard in-person examination amongst a sample population of glaucoma suspect patients in rural Alberta. Methods: 76 new glaucoma suspect patients from rural Alberta were selected if they had experienced both a teleglaucoma virtual exam (history, exam and diagnostic information uploaded from their local optometrist visit), as well as a traditional ophthalmologist-based in-person assessment over the past two years. A 5-point Likert scale structured patient questionnaire was carried out by an independent trained staff over the telephone. The questionnaire consisted of twelve questions, which compared patient experiences and preferences between their teleglaucoma and ophthalmologist-based consultations. University of Alberta REB approval was obtained. Results: Of the 76 patients that fit the selection criteria, 23 (30% response rate) were successfully contacted by telephone. Patients traveled less total distances for their teleglaucoma visit as compared to their ophthalmologist-based screening exam (69.25+/- 117 km vs /-198 km). Patients also spent less time at the teleglaucoma visit (0.40 +/ hours) as compared to the inperson ophthalmologist exam (1.51 +/ hours). Analysis of the questionnaire (1-strongly disagree to 5-strongly agree), showed that patients were satisfied with their teleglaucoma examination (4.5+/- 0.84). Furthermore, when asked about their choice of glaucoma screening in the future, patients preferred to use teleglaucoma (4.26+/-1.38). Patients cited time saving (91.3%), convenience (91.3%), and lower cost (60.9%) as the primary benefits of teleglaucoma. Conclusions: This study demonstrates high patient satisfaction with a teleglaucoma exam when compared to in person ophthalmologist care in patients at risk for glaucoma in rural Alberta. Patients report that teleglaucoma reduces travel distance, time, and associated cost for those being screened as glaucoma suspects. Studies validating the model by comparing in-person to tele-examination are underway by our group. Patient care pathway using Telelglaucoma for detection and management of glaucoma through a collaborative care model with optometrists. Commercial Relationships: Sourabh Arora, None; Khaliq Kurji, None; Irfan Kherani, None; Christopher J. Rudnisky, Secure Diagnostic Imaging Ltd. (C); Karim F. Damji, None Program Number: 6101 Poster Board Number: A0228 Comparing the subjective and the objective severity of affections observed at emergency room in ophthalmology Aurelie Pison 1, Pierre Raphael Rothschild 1, 2, Chadi Mehanna 1, Antoine P. Brezin 1, Jean-Louis Bourges 1, 2. 1 Ophthalmology, Pole Hotel-Dieu Cochin, site Hotel-Dieu, Sorbonne Paris Cité university, Paris Descartes School of medicine, Assistance Publique-Hopitaux de Paris, Paris, France; 2 Team 17, INSERM UMRS 872, CIC des Cordeliers, Paris, France. Purpose: The triage process at ophthalmological emergencies (OER) evaluates the severity of ocular conditions. However, the concept of severity is imprecise, and differently approached. We compared the subjective severity perceived by patients and the objective evaluation of severity provided by physicians. A pilot study conducted retrospectively over 6 months on 3003 patients revealed that patients tended underestimating the severity of their affection. We aimed to investigate that discrepancy prospectively. Methods: Both patients and physicians were enrolled to quantify the severity of the ocular condition referred to OER over two months (July and October 2013). A nurse collected patient s subjective score of ocular condition severity from 0 (no severity) to 6 (maximal) and graded patient s behavior from 0 (normal) to 5 (violent or highly incoherent). After examination, the ophthalmologist provided an objective severity score for the same ocular condition. Data were analyzed prospectively and anonymously. Results: We collected 4478 forms of which 78 % were correctly completed both by the nurse and the physician (n=3486). The average age of the patients was years (43.02 to 44.14; IC 95%). Half of the patients displayed a normal behavior (score 0; n=2227). The mean behavior score was Only one patient scored 5. The severity couldn t be scored by 755 patients (17%). Patients scored severity as none, minor, moderate, serious, severe, critical or maximal in 682, 1296, 1018, 530, 111, 16, and 4 cases, and by ophthalmologists in 1553, 624, 1159, 634, 296, 87 and 47 cases, respectively. The severity was scored identically both by the ophthalmologist and the patient in 20 % of the cases (293, 180, 299, 86, 19, 2 and 0 cases respectively).

12 The subjective score was lower than the objective for 300 patients and higher for 75 patients. Conclusions: The trend of the pilot study is prospectively confirmed.the severity of ocular affections seen at OER is differently scored by patients or by ophthalmologists, and tend to be underestimated by patients. Half of the patients modified their behavior due to their ocular condition. Commercial Relationships: Aurelie Pison, None; Pierre Raphael Rothschild, None; Chadi Mehanna, None; Antoine P. Brezin, None; Jean-Louis Bourges, None Program Number: 6102 Poster Board Number: A0229 Impact of the Lions Lens on a school vision clinic and on child s perception of academic performance Sandra S. Block, Melissa A. Suckow. School-Based Vision Clinic, Illinois College of Optometry, Chicago, IL. Purpose: Lions Clubs International Foundation and Essilor created the Lions lens to address uncorrected refractive error (RE). Illinois Eye Institute (IEI) became a pilot site. The Lions lens was distributed at the IEI School-based vision clinic in Chicago to students insured through state health insurance. Medicaid typically takes 2-4 months to deliver glasses. The Lions lens was delivered faster. A pre-survey was developed to see if these patients had visual complaints and felt a vision intervention would benefit academic performance. A post-survey was administered after they had their glasses for several weeks. The post-survey investigated perceptions of the glasses and whether they felt a positive or negative impact. Methods: Children presenting to the clinic during 10/12-5/13, who had state insurance and needed spectacles were included under the Lions grant. On the day of their exam, they completed a pre-survey. The survey was read if they needed help. When ready, glasses were delivered and the child was instructed on wearing schedule (always, reading only, or distance only). Several weeks later (3-6 weeks), the post-survey was completed. Results: 1,109 children fit criteria for the Lions lens. Of those, 56% were female, 62% Black, 34.3% Hispanic, 1.6% Asian, & 1.6% White. The subjects ranged from <1 year to 21 years of age (mean 11.7 SD 3.3). RE (OD) ranged from sphere: D (mean SD 2.15) cylinder: range up to -8.00D (mean 1.20 SD 1.12). At least 2 lines of improvement in visual acuity were seen in 49.1% with the new correction. Pre-survey question responses showed 65.5% of the children felt school work would improve with exam. Post survey showed 73.9% felt the school improved with the new glasses. Percentages decreased from elementary school (78.3%) to high school 65.8%). Conclusions: Many children felt academic performance improved with the Lions correction. While no data exists supporting actual changes in grades in school, it is important that children had a positive attitude towards visual correction. The children seen at this clinic are low income inner city children with limited access to regular eye care services. Since Illinois has offered insurance that covers eyecare low income children for several years, it is uncertain whether the affordable care act will improve access for our population. Commercial Relationships: Sandra S. Block, None; Melissa A. Suckow, None Support: IL Chidren s Healthcare Foundtion, Lions Clubs International Foundation, Essilor, Polk Bros. Program Number: 6103 Poster Board Number: A0230 Glaucoma Screening in African American Communities: A Comparative Effectiveness Analysis Reena Vaswani, Lama A. Al-Aswad, George A. Cioffi, Dana M. Blumberg. Columbia University, New York, NY. Purpose: Despite the fact that glaucoma is the leading cause of blindness in African Americans (AA) in the United States, up to 75% of patients with glaucoma remain undetected. Ocular coherence tomography (OCT) has potential to detect glaucoma in the community setting, however there are no long-term trials proving its effectiveness. The purpose of this study is to project the effect of OCT screening and earlier treatment, on visual outcomes in AA patients. Methods: A Monte Carlo micro-simulation model was developed to evaluate the visual field impact and economic burden of communitybased glaucoma screening, with 50,000 AA patients 50 years or older over a 10-year period. For the purposes of this model, we assumed a 60% follow up rate after failed screening. Results: The costs associated with screening 50,000 AAs with no prior diagnosis of glaucoma were approximately $98 per patient screened. When treatment was accounted for, costs rose to $795 for each patient screened over 10 years. In our model, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%. At 10 years, 6.1% fewer patients progressed to severe visual field loss and 14.8% more patients remained in the mild visual field loss when comparing screened versus not screened groups. The results of the model were subject to variability based on: age, initial visual field status, follow up rate, medication efficacy, and OCT test sensitivity and specificity. Increasing the follow up rate from 60% to 80% decreased the prevalence of severe visual field loss by 17.6% in the screened group compared the not screened group. This is an improvement of 9% when compared with 60% follow up rate. Conclusions: Our model shows that OCT screening is effective at reducing visual field loss, with a low cost per individual screened. OCT screening significantly reduced the number of undiagnosed cases of glaucoma in a high-risk population. Additionally, early identification and treatment significantly decreased the number of patients suffering from severe visual field loss at the 10-year time horizon and increased the number of patients maintaining mild visual field loss. This study supports the fact that follow up rate is an important modifiable factor to improve efficacy of screening and decrease morbidity associated with glaucoma. Commercial Relationships: Reena Vaswani, None; Lama A. Al- Aswad, None; George A. Cioffi, None; Dana M. Blumberg, None Program Number: 6104 Poster Board Number: A0231 Final versus referral diagnosis of visual impairment in a tertiary low vision rehabilitation centre for children Evelyn Longhin 1, Marco Vinciati 2, Iveta Cermakova 2, Gloria Zabeo 3, Enrica Convento 3, Iva A. Fregona 3, Raffaele Parrozzani 1, Edoardo Midena 1, 3. 1 Fondazione G. B. Bietti IRCCS, Rome, Italy; 2 Robert Hollman Foundation, Padova, Italy; 3 Department of Ophthalmology, University of Padova, Padova, Italy. Purpose: To compare the final diagnosis of the cause of low vision in children attending a tertiary rehabilitation centre for visually impaired children versus referring ophthalmological diagnosis. Methods: Retrospective review of clinical charts of all (theoretically) visually impaired children referred to the Robert Hollman Foundation (RHF), a tertiary rehabilitation centre for visually impaired children, between January 2010 and June The following clinical data were analysed: entry diagnosis made by the referral ophthalmologist;

13 final clinical diagnosis made at RHF based on a complete ophthalmic evaluation, including: best corrected visual acuity (preferential looking test, Lea symbols or EDTRS chart according to children s age and cooperation) and, when necessary, optical coherence tomography, ultrasounds, visual evoked potentials, full field electroretinography and fluorescein angiography. Results: Ninety-two consecutive children with a mean age of 2.37±1.98 years (range: 0-9 years) were included. A full referral diagnosis was retrieved in 76 cases (82.6%), including: cerebral visual impairment (CVI) (17.3%), retinopathy of prematurity (ROP: 17.3%), hereditary retinal diseases (13.3%), nystagmus (10.7%), systemic syndromes involving the eye (9.3%), congenital cataract (8%), optic nerve atrophy (8%) and other rarer diseases (16.1%). In the remaining 17.4% (16 children) a precise referral diagnosis was unavailable (indeterminate suspected visual impairment). Final clinical diagnosis made at RHF was: normal visual function in 8.7%, CVI in 30.4%, ROP in 10.8%, hereditary retinal disease in 9.8%, optic atrophy in 6.5%, congenital cataract in 6.5%, systemic syndrome in 6.5%, nystagmus in 5.4% and other in In 33 cases (35.9%) the diagnosis made at the RHF did not confirm the entry diagnosis, with 17 cases (18.5%) originally fully misdiagnosed. Conclusions: Approximately one-third of referred visually impaired children were misdiagnosed at baseline. The activity of an ophthalmic tertiary rehabilitation centre with highly trained and experienced ophthalmologists is essential to offer a precise diagnosis to visually impaired (sometimes with other deficits) children, and allows planning a tailored, full rehabilitation programme, which is mandatory in childhood, when a functional visual recovery is sometimes possible. Commercial Relationships: Evelyn Longhin, None; Marco Vinciati, None; Iveta Cermakova, None; Gloria Zabeo, None; Enrica Convento, None; Iva A. Fregona, None; Raffaele Parrozzani, None; Edoardo Midena, None Program Number: 6105 Poster Board Number: A0232 Incidence and frequency of positive findings in inpatient ophthalmology consultations at Boston Medical Center Neil Vyas, John Gittinger. Ophthalmology, Boston University/Boston Medical Center, Boston, MA. Purpose: Boston Medical Center (BMC) is a busy Level -1 trauma and tertiary care center in New England. It is also the safety net hospital for low income, underinsured, and uninsured patients in Massachusetts. Given the high volume of admitted patients, the inpatient ophthalmology consult service is quite busy. We evaluate the types of inpatient ophthalmology consultations and what interventions, if any, were performed as a result of the consultation. Methods: Retrospective chart review of consecutive inpatient ophthalmology consultations at BMC, including those originating from the emergency room who were being admitted, over a 3 month period from October-December 2012 with no exclusion criteria. Reason for consultation, ophthalmologic findings, and any new interventions or changes in overall treatment plan were recorded. Results: 106 patients were evaluated. The most common reason for consultation was orbital bone fracture (23/106). None required acute intervention. Consultation status post neurosurgical intervention was also common (7/106) with no changes in neurosurgical plan based on eye findings. Of patients with subjective blurry vision or discomfort without known ocular diagnoses, dry eye was the most common etiology (7/12). In AIDS patients with low CD4 counts <50, 4/12 had positive intraocular findings. All patients with transient monocular vision loss with full visual recovery (4/4) had normal exams. All patients with systemic candidemia were negative for fungal endophthalmitis (6/6). Conclusions: For two of the most common reasons for ophthalmology inpatient consultation orbital fracture and post neuro-surgical intervention no acute intervention was required. In addition, in patients with new blurry vision and discomfort without prior ophthalmologic co-morbidities, especially in those with long hospital stays, dry eye was most often the culprit. In contrast, there was a relatively high incidence of positive findings in patients with immunosuppression secondary to AIDS. In a busy hospital setting, effective triage of patients is often necessary. This study may provide a positive predictive value on which patients may have ophthalmologic findings based on initial reason for consultation and may also help primary teams begin empiric therapy on patients prior to ophthalmologic consultation (such as artificial tears) to help resolve patient discomfort more rapidly. Commercial Relationships: Neil Vyas, None; John Gittinger, None Program Number: 6106 Poster Board Number: A0233 New referrals to an Australian ophthalmic outpatient clinic Fiona Stapleton 1, Simon C. Lim 1, Micheal Knipe 2, Nitin Verma 2. 1 School of Optometry and Vision Science, University of New South Wales, Kensington Sydney, NSW, Australia; 2 Eye Clinic, Royal Hobart Hospital, Hobart, TAS, Australia. Purpose: There are limited data on the patterns and quality of referrals to ophthalmic clinics in Australia. This study reports patient demographics, reason for referral and final diagnosis in new patients referred to the eye clinic at the Royal Hobart Hospital Methods: Electronic medical records for new referrals attending the eye clinic at the Royal Hobart Hospital between January and April 30th 2012 were audited. Patient age, gender, index of relative social disadvantage (IRSD, based on postcode), referrer, reason for referral and final diagnosis (classified according to the International Classification of Disease codes (ICD-10)) were recorded. Concordance between reason for referral and final diagnosis was determined. Results: 440 new patients presented during the study and 48% were female. Mean age was 47±27 years, and there was a bimodal distribution with peaks at 5 years and 65 years. The mean IRSD was 954±73. The most common referrals were for disorders of muscles, binocular movement, accommodation and refraction (16.2%), disorders of the lens (12.3%) and injury of eye and orbit (11.9%). Diabetes/diabetic retinopathy and glaucoma comprised 8.2% and 5.3% of new referrals respectively. Concordance analysis was performed for 366 patients with a valid referral letter. High concordance (80%<) was seen for diagnoses of disorders of the lens, glaucoma, diabetes, disorders of eyelid, lacrimal system and orbit, and congenital abnormalities. Poor concordance was seen for diagnoses of disorders of muscles, binocular movement, accommodation and refraction (63%) and for disorders of conjunctiva, and disorders of sclera, cornea, iris and ciliary body (55%). Referrals from optometrists and general practitioners showed high concordance with final diagnoses (92% and 82% respectively). Conclusions: Analysis of current patient referral trends to an ophthalmic outpatient clinic provides valuable information in allocation of hospital resources and in improving quality of referrals. Commercial Relationships: Fiona Stapleton, None; Simon C. Lim, None; Micheal Knipe, None; Nitin Verma, None

14 Program Number: 6107 Poster Board Number: A0234 Variability in Access to Hospital Eye Care in Southern China Yingfeng Zheng, Decai Wang, Mingguang He. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Purpose: To examine geographic variation in patient access to hospital eye care services and to examine determinants of these services in Southern China. Methods: In April to August 2010, a questionnaire survey was carried out to investigate the availability of medical and surgical eye care services in fiscal year 2009 in all regional (secondary) and tertiary hospitals in Guangdong Province, southern China. A hospital was considered to have eye care services when there were registered ophthalmologists serving in the hospital. Hospital locations were classified as rural and urban regions. Results: A total of 348 of the surveyed hospitals provided valid data for analysis, giving a 78% response rate. A total of 100% of urban regions and 83.8% of rural regions provided eye care service. There was no significant difference in the availability of manual smallincision cataract surgery between rural and urban regions (77.9% vs. 88.9%), but rural hospitals were much less likely to provide advanced surgical procedures (vitreoretinal surgery: 10.3% in rural vs. 77.8% in urban; phacoemulsification: 45.6% vs. 94.4%; corneal transplant: 7.3% vs. 50.0%) and emergency eye care (88.2% vs. 100%). Factors significantly associated (p < 0.05) with hospital eye care included hospital levels (provincial, city and county levels) and geographical characteristics (including gross domestic product (GDP), individual earnings and population size). For-profit hospitals were more likely to provide more profitable care (e.g., LASIK and laser vision correction) when compared with public hospitals. Conclusions: One-fifth of the rural hospitals do not establish eye care service, and there is a wide variation in access to surgical eye care between rural and urban settings. These findings indicate a need for training programs, capacity building and improvement in quality of infrastructure in rural China. Commercial Relationships: Yingfeng Zheng, None; Decai Wang, None; Mingguang He, None Support: National Natural Science Foundation of China by primary care services and clinician referral. Waiting time for ophthalmology consultation is between 30 and 60 days. There is a waiting list for appointments in 58.0% of the municipalities totaling 27,159 patients. The total number of consultations available is approximately 21,512 a month. There are 115 ophthalmologists acting in the public service and there are 57 offices with basic ophthalmologic equipment. Patients of greater complexity are referred to appropriate services. There is no emergency assistance in ophthalmology, and 82.3% of the municipalities do not have operating room facilities for ophthalmology. There are waiting lists for cataract surgery in 80.6% of the municipalities. The majority of queues (81.8%) are concentrated in 8 cities and there are no data regarding queues for diseases of the retina. There is a system for reference and counter reference of patients in 53.2% of the municipalities and the majority does not have clinical protocols for ophthalmology. Conclusions: The main difficulties found in the organization of care are related to flow of patients with more complex problems (referral, surgeries and procedures of retina). This study corroborates the necessity of organizing flow patient so that the available resources are better placed and investments can be made in order to attend the identified needs. Commercial Relationships: Denise F. Oliveira, None; Carlos E. Arieta, None Program Number: 6108 Poster Board Number: A0235 Demand, capacity and flow of care in ophthalmology in the Campinas region, Brazil Denise F. Oliveira, Carlos E. Arieta. OPhthalmology, UNICAMP, Campinas, Brazil. Purpose: This study aims to evaluate and characterize the ophthalmologic care within the Brazilian Health System (SUS) in the region of Campinas, and provide support for the network configuration of a regionalized health care in ophthalmology Methods: We conducted a cross sectional study which included 62 cities from the State of São Paulo, that comprise the Regionalized Network for Health Care. Were evaluated service strategies, profiles of the professionals, integrated services of ophthalmologic care and also the thoughts of the health managers about the needs and requirements to achieve a quality care to the population. The Clinical Hospital of Unicamp is the reference for high complexity in this region. 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