Significance of Timely Referral for oGVHD and NIH Stage at Presentation American Academy of Optometry Annual Meeting Supplement 2020
Date
10/07/2020Abstract
Purpose: -Identify the first onset of ocular surface disease symptoms in hematopoieticcell transplants patients by hematology providers, the days to referral to the advanced ocular surface disease clinic and the severity of disease on consultation.
-Examine whether department educational initiatives for primary providers of graft versus host disease patients influenced timing of referrals and National Institutes of Health ocular graft versus host disease stage at presentation. These included:
1) Pathophysiology and ocular findings to hemotology providers
2) Current treatment of ocular graft versus host disease
3) Available ocular disease clinic resources
4) Develop co-departmental patient care lines
Methods: -Retrospective chart review of 124 graft versus host disease patients seen over 36 months in the ocular surface disease clinic in relationship to demographics, onset of symptoms and referral time after bone marrow transplantation.
-Data reviewed included:
1) Demographic information (age, gender, ethnicity, oncologic diagnosis)
2) Date of allogenic stem cell transplant
3) Date of onset ocular symptoms
4) Date of referral for ocular graft versus host disease
5) Date of initial advanced ocular surface disease clinic consultation
6) National Institute of Health score at initial advanced ocular surface disease clinic consultation
7) Chronic graft versus host disease treatments (steroid-resistant medications, extracorporeal photopheresis)
-Inclusion criteria: 1) Internal referrals from hematology department for patients with ocular graft verus host symptoms (n=98) seen between March 2017 and March 2020
-Exclusion criteria: 1) Patients under the age of 18 years old 2) External graft versus host referrals from other practioners (n=26) 3) Patients with previously diagnosed ocular surface disease not related to transplantation
Results: Impact on National Institutes Grade
Pre-Education Initiatives
Grade 0 2%
Grade 1 39%
Grade 2 54%
Grade 3 5%
Post-Education Initiatives
Grade 0 17%
Grade 1 63%
Grade 2 17%
Grade 3 2%
p=0.00028915
Impact of Education Initiatives of Time to Referral After Onset of Ocular Symptoms
Pre-Education Initiative
M=102 days, Range 21-721 days
Post-Education Initiative
M=17, Range 0-130
p=0.000015
Results: This study demonstrated the usefulness of educational initiatives to improve patient care lines between medical center departments. The National Institutes of Health ocular graft versus host disease grades were improved from 41% grade 0/1 pre-initiative to 80% grade 0/1 post-initiative. Supporting this finding is that the length of time from presentation of ocular symptoms to referral to the advanced ocular surface disease clinic decreased substantially from a mean of 102 days pre-initiative to 17 days post-initiative. Both of these findings are statistically significant.
Author List
John Conto, OD Ryan Johnson, MD Joseph Bogaard, MD, PhDAuthor
John Elliott Conto OD Associate Professor in the Ophthalmology and Visual Sciences department at Medical College of WisconsinView Online
