Certification and Credentials of Intravitreal Injection Proceduralists in the United States

Vo, Loi V.; Lapakko, Zachary J.; Leder, Henry A.; Mason, Robert W.; Lee, Gregory D.; VanderBeek, Brian L.; Emerson, Geoffrey G.

doi:10.1016/j.oret.2020.10.006

Cited by 9 publications

(11 citation statements)

References 4 publications

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“…Despite nearly 3 million injections in our investigation, there were relatively few injections in the non–ABO-certified and nonretina cohorts, reflecting the US intravitreal injection landscape where the majority of providers in the United States are board certified and have completed a fellowship. 10 In turn, the low numbers in the non-ABO and the nonretina cohorts (64 and 61 endophthalmitis outcomes, respectively) limited statistical power for comparison between those in and out of the studied group. Indeed, our study was not sufficiently powered to distinguish a difference between the retina- and the nonretina-trained groups, possibly because of the small nonretina cohort, the rarity of endophthalmitis complications, and/or dilution between cohorts as discussed earlier.…”

Section: Discussionmentioning

confidence: 99%

“…ABO board-certification status was determined for each provider from ABO's "Verify a Physician" webpage (https:// abop.org/verify-a-physician; accessed November-December 2019). Postresidency retina fellowship training was determined using an internet search algorithm previously described, 10 from the webpages of the ABO (https://abop.org/verify-a-physi cian), American Academy of Ophthalmology (AAO; https:// secure.aao.org/aao/find-ophthalmologist), American Society of Retina Specialists (ASRS; https://www.asrs.org/find-a-spe cialist), Doximity (https://www.doximity.com/directory/physi cians), and the proceduralist's clinic and/or hospital webpage as identified by Google (accessed October 2019-April 2020). Discrepancies on the various webpages were uncommon, but when they were encountered we considered case by case whether to favor the information listed on the ABO, AAO, or ASRS webpages.…”

Section: Methodsmentioning

confidence: 99%

“…Meanwhile, intravitreal injection is increasing in volume by 6% per year in the United States, 10 raising the question of how to manage the growing treatment burden on ophthalmologists if current volumes increase as populations age. The United Kingdom has addressed its shortage of capacity for intravitreal injection through a program of nurse-administered intravitreal injections supervised by a vitreoretinal consultant.…”

Section: Introductionmentioning

confidence: 99%

“…11 In contrast, intravitreal injections in the United States are administered by ophthalmologists (usually fellowship-trained retina specialists). 10 Because of their training, retina specialists are most prepared to manage the complications of intravitreal injection, including endophthalmitis. However, whether the training and/or certification of the provider affects the risk of endophthalmitis has yet to be evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections

Emerson

Rahman

Kim

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: This work investigates associations between physician qualifications and the risk of postintravitreal injection endophthalmitis. Methods: This retrospective analysis of data from medical claims studied Medicare beneficiaries undergoing 1 or more intravitreal injections between January 1, 2013, and December 31, 2017. Logistic regression analysis was performed to assess whether board certification status or retina subspecialty training was associated with lower risk of postinjection endophthalmitis, controlling for patient's age, race, and sex, type of agent injected, diagnosis, and year of injection. The main outcome measure was odds ratio (OR) of receiving a diagnosis of endophthalmitis in the 14 days after intravitreal injection. Clinical outcome and quality of care were not evaluated in this study. Results: A total of 2 907 324 intravitreal injections were performed on 219 640 patients by 4315 ophthalmologists, 3196 (74%) of whom were retina specialists and 4021 (92%) of whom were certified by the American Board of Ophthalmology (ABO). Overall, there were 1088 (0.037%) cases of postinjection endophthalmitis, of which 1024 (0.037%) were injected by ABO-certified ophthalmologists and 64 (0.050%) by non–board-certified ophthalmologists. Injections by ABO-certified ophthalmologist had 28% reduced odds of endophthalmitis (OR = 0.72; 95% CI, 0.523-0.996, P = .05). Higher odds of endophthalmitis were observed for corticosteroid injections (OR = 3.91; 95% CI, 2.75-5.56, P < .001) and aflibercept injections (OR = 1.47; 95% CI, 1.19-1.80, P < .001). Patients' sex and race, the diagnosis associated with the injection, and providers' retina subspeciality training were not associated with the rate of endophthalmitis ( P < .20 for all comparisons). Conclusions: We found evidence that endophthalmitis may be reduced when ABO-certified physicians perform an intravitreal injection.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections

Emerson

Rahman

Kim

et al. 2021

Journal of VitreoRetinal Diseases

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“…Intravitreal injection is the most common eye procedure worldwide 1 and is increasing in use by 6% annually in the United States. 2 Intravitreal injections have revolutionized retinal disease management and enabled dramatically improved prognosis to patients with potentially blinding retinal disease. Despite being common, intravitreal injection therapy is rarely "standard," given the complexity of decision-making required for patients' treatment.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Injection Therapy: Current Techniques and Supplemental Services

Lam

Mehta

Lad

et al. 2021

Journal of VitreoRetinal Diseases

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Purpose: Intravitreal injection is the most frequently performed eye procedure in the world and is an essential component in the management of sight-threating retinal diseases and conditions. Given the seriousness and range of diseases treated and the risks of the procedure, retina specialists must weigh the pros and cons of each individual treatment. Complexities guiding injection treatment are multifaceted and involve patient-history review, careful examination, diagnostic testing selection and interpretation, customized medical decision-making, and follow-up considerations. Methods: This article by the Intravitreal Injection Task Force Committee of the American Society of Retina Specialists documents the intricacies and necessary components of the intravitreal injection procedure. Results: By expert consensus, the task force further recommends ancillary services and decision-making that may accompany intravitreal injection visits, when appropriate, to monitor response to treatment, adjust treatment, and manage additional considerations in the same or fellow eye. Conclusions: Retina specialists can optimize safety and therapeutic outcomes with individualized consideration and customization of intravitreal injection treatment for each patient.

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Endophthalmitis Rates and Types of Treatments After Intraocular Procedures

VanderBeek,

Chen,

Tomaiuolo

et al. 2024

JAMA Ophthalmol

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ImportanceLong-term trend analyses of overall endophthalmitis rates and treatment patterns are scarce. It is also unknown if the deviation from the recommendations of the Endophthalmitis Vitrectomy Study toward decreased utilization of vitrectomy is associated with different vision outcomes.ObjectiveTo determine whether the rate of endophthalmitis after intraocular procedures or the primary treatment (prompt vitrectomy vs tap and inject) for endophthalmitis has changed over the past 20 years.Design, Setting, and ParticipantsThis cohort study examined data for cohorts created by querying for different intraocular procedures, including intravitreal injections and surgeries for cataract removal, glaucoma, retinal conditions, and corneal transplants from 2000 to 2022. The data source was a US administrative medical claims database comprising commercial and Medicare Advantage insurance plans. Any intraocular procedure with at least 6 months of data available before and 6 weeks after the procedure was eligible. Exclusion criteria consisted of any previous diagnosis of endophthalmitis or another intraocular procedure during the follow-up period.Main Outcome MeasureThe main outcomes were rate of postprocedure endophthalmitis and relative rate of prompt vitrectomy (vs tap and inject) as the primary method of treatment.ResultsAmong 2 124 964 patients, the mean (SD) age was 71.4 (10.2) years; 1 230 320 were female and 894 414 male. Over 22 years, 5 827 809 intraocular procedures were analyzed with 4305 cases of endophthalmitis found for an overall endophthalmitis rate of 0.07%. The yearly rate of endophthalmitis varied but generally declined from a high of 7 cases per 3502 procedures (0.20%) in 2000 to a low of 163 cases per 332 159 procedures (0.05%) in 2022. The percentage of cases treated with prompt vitrectomy also varied but generally declined over time with a high of 17 of 35 (48.6%) in 2003 and a low of 60 of 515 (11.6%) in 2021. Multivariable analysis of the endophthalmitis incidence rate ratio (IRR) showed a per-year decrease of 2.7% (IRR, 0.97; 95% CI, 0.97-0.98; P &lt; .001) over the study period. A similar analysis also showed that the incidence rate of prompt surgical treatment decreased by 3.8% per year throughout the study period (IRR, 0.96; 95% CI, 0.95-0.97; P &lt; .001).Conclusions and RelevanceThis study found that the incidence of endophthalmitis following intraocular procedures appears to have decreased substantially over the past 20 years while prompt vitrectomy is being used less frequently as primary treatment than in the past.

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Certification and Credentials of Intravitreal Injection Proceduralists in the United States

Cited by 9 publications

References 4 publications

Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections

Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections

Intravitreal Injection Therapy: Current Techniques and Supplemental Services

Endophthalmitis Rates and Types of Treatments After Intraocular Procedures

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