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Ophthalmologic assessments in patients with newly diagnosed sarcoidosis: An observational study from a universal healthcare system

  • Lee M. Fidler
    Correspondence
    Corresponding author. Sunnybrook Health Sciences Centre, 2075 Bayview Ave. Rm A459, Toronto, ON, M4N 3M5, Canada.
    Affiliations
    Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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  • Meyer Balter
    Affiliations
    Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Jolene H. Fisher
    Affiliations
    Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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  • Matthew B. Stanbrook
    Affiliations
    Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada

    ICES, Toronto, Ontario, Canada
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  • Teresa To
    Affiliations
    ICES, Toronto, Ontario, Canada

    Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

    Dalla Lana School of Public Health, Toronto, Ontario, Canada
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  • Radha Kohly
    Affiliations
    Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Andrea S. Gershon
    Affiliations
    Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    ICES, Toronto, Ontario, Canada

    Dalla Lana School of Public Health, Toronto, Ontario, Canada
    Search for articles by this author
Published:August 12, 2021DOI:https://doi.org/10.1016/j.rmed.2021.106575

      Highlights

      • Most patients with sarcoidosis (~2/3) complete eye examinations around the time of diagnosis, though many do not.
      • Access to regional ophthalmologists may impact local eye screening rates in sarcoidosis.
      • Sex, age, and immigration status are important factors associated with ophthalmologic screening.

      Abstract

      Introduction

      Consensus guidelines for the management of sarcoidosis recommend screening eye examinations for all patients, even in those without ocular symptoms. We aimed to determine the proportion of sarcoidosis patients that complete ophthalmologic evaluations and factors associated with their performance.

      Methods

      We identified patients with sarcoidosis using population health services data from Ontario, Canada between 1991 and 2019. Sarcoidosis was defined by ≥ 2 physician visits for sarcoidosis within a two-year period. Ophthalmologic evaluations were based on an optometrist or ophthalmologist visit within the year prior or two years following the diagnosis. We estimated correlations between the number of eye care professionals and proportion of sarcoidosis patients completing ophthalmologic assessments within regional health units. We evaluated for associations between ophthalmologic screening and patient characteristics using multivariable logistic regression.

      Results

      We identified 21,679 patients with sarcoidosis in Ontario. An ophthalmologic evaluation was performed in 14,751 (68.0%), with a similar number of individuals seeing ophthalmologists and optometrists (43.7% vs. 42.2%). The percentage of sarcoidosis patients undergoing an ophthalmologic evaluation within corresponding regional health units was moderately correlated with the number of practicing ophthalmologists (r = 0.64, p = 0.01), but not the number of optometrists (r = 0.08, p = 0.77). Patients who were older [OR per year 1.02 (95% CI 1.01–1.02), p < 0.001] and female [OR 1.54 (95% CI 1.44–1.63), p < 0.001] were more likely to complete ophthalmologic evaluations. Immigrants to Canada were less likely to undergo ophthalmologic assessments [OR 0.66 (95% CI 0.60–0.73), p < 0.001].

      Conclusions

      Most patients with sarcoidosis complete ophthalmologic examinations, though a substantial proportion does not. Young adults, men and immigrants were less likely to complete ophthalmologic evaluations. Limited access to ophthalmologists may at least in part explain why some sarcoidosis patients fail to complete ophthalmologic screening.

      Keywords

      Abbreviations:

      ICD-9/10 (International Classification of Diseases, Ninth/Tenth Revision codes), OHIP (Ontario Health Insurance Plan)
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      References

        • Jamilloux Y.
        • KodjikianL
        • Broussolle C.
        • Seve P.
        Sarcoidosis and uveitis.
        Autoimmun. Rev. 2014; 13: 840-849
        • Crouser E.D.
        • Maier L.A.
        • Wilson K.C.
        • Bonham C.A.
        • Morgenthau A.S.
        • Patterson K.C.
        • et al.
        Diagnosis and detection of sarcoidosis. An official American Thoracic Society clinical practice guideline.
        Am. J. Respir. Crit. Care Med. 2020; 201: e26
        • Dammacco R.
        • Biswas J.
        • Kivela T.T.
        • Zito F.A.
        • Leone P.
        • Mavilio A.
        • et al.
        Ocular sarcoidosis: clinical experience and recent pathogenetic and therapeutic advancements.
        Int. Ophthalmol. 2020; 40: 3453-3467
        • Heiligenhaus A.
        • Wefelmeyer D.
        • Wefelmeyer E.
        • Rosel M.
        • Schrenk M.
        The eye as a common site for the early clinical manifestation of sarcoidosis.
        Ophthalmic Res. 2011; 46: 9-12
        • Pefkianaki M.
        • Androudi S.
        • Praidou A.
        • Sourlas V.
        • Epameinondas Z.
        • Brazitikos P.
        • et al.
        Ocular disease awareness and pattern of ocular manifestation in patients with biopsy-proven lung sarcoidosis.
        J Ophthalmic Inflamm Infect. 2011; 1: 141-145
        • Mochizuki M.
        • Smith J.R.
        • Takase H.
        • Kaburaki T.
        • Achyara N.R.
        Revised criteria of international workshop on ocular sarcoidosis (IWOS) for the diagnosis of ocular sarcoidosis.
        Br. J. Ophthalmol. 2019; 103: 1418-1422
      1. https://www.ontario.ca/page/what-ohip-covers. (Feb 28 2021).

        • Fidler L.M.
        • Balter M.
        • Fisher J.H.
        • To T.
        • Stanbrook M.B.
        • Gershon A.
        Epidemiology and health outcomes in sarcoidsois in a universal health care population: a cohort study.
        Eur. Respir. J. 2019; 54: 1900444
      2. Statement on sarcoidosis, joint statement of the American thoracic society (ATS), the European respiratory society (ERS) and the world association of sarcoidosis and other granulomatous disorders (WASOG) adopted by the ATS board of directors and by the ERS executive committee.
        Am. J. Respir. Crit. Care Med. 1999; 160 (February 1999): 736-755
        • Austin P.C.
        Using standardized difference to compare the prevalence of a binary variable between two groups in observational research.
        Commun. Stat. Simulat. Comput. 2009; 38: 1228-1234
        • Jin Y.
        • Trope G.E.
        Eye care utilization in Canada: disparity in the publicly funded health care system.
        Can. J. Ophthalmol. 2011; 46: 133-138
        • Aljied R.
        • Aubin M.J.
        • Buhrmann R.
        • Sabeti S.
        • Freeman E.E.
        Eye care utilization and its determinants in Canada.
        Can. J. Ophthalmol. 2018; 53: 298-304
        • Baughman R.P.
        • Scholand M.B.
        • Rahaghi F.F.
        Clinical phenotyping: role in treatment decisions in sarcoidosis.
        Eur. Respir. Rev. 2020; 29: 190145
        • Rothova A.
        • Alberts C.
        • Glasius E.
        • Kijlstra A.
        • Buitenhuis H.J.
        • Breebaart A.C.
        Risk factors for ocular sarcoidosis.
        Doc. Ophthalmol. 1989; 72: 287-296
        • Lau J.S.
        • Adams S.H.
        • Boscardin W.J.
        • Irwin Jr., C.E.
        Young adults' health care utilization and expenditures prior to the affordable care act.
        J. Adolesc. Health. 2014; 54: 663-671
        • Hennessy T.W.
        • Ballard D.J.
        • DeRemee R.A.
        • Chu C.P.
        • Melton 3rd, L.J.
        The influence of diagnostic access bias on the epidemiology of sarcoidosis: a population-based study in Rochester, Minnestora, 1935-1984.
        J. Clin. Epidemiol. 1988; 41: 565-570
        • McKinlay J.B.
        Some issues associated with migration, health status and the use of health services.
        J. Chron. Dis. 1975; 28 (579-572)
        • Harper L.J.
        • Gerke A.K.
        • Xiao-Feng W.
        • Ribeiro Neto M.L.
        • Baughman R.P.
        • Beyer K.
        • et al.
        Income and other contributors to poor outcomes in U.S. patients with sarcoidosis.
        Am. J. Respir. Crit. Care Med. 2020; 201: 955-964
        • Saligan L.N.
        • Levy-Clarke G.
        • Wu T.
        • Faia L.J.
        • Wroblewski K.
        • Yeh S.
        • et al.
        Quality of life in sarcoidosis: comparing the impact of ocular and non-ocular involvement of disease.
        Opthalmic Epidemiol. 2010; 17: 217-224
        • Haider A.
        • Mamdani M.
        • Shaw J.C.
        • Alter D.A.
        • Shear N.H.
        Socioeconomic status influences care of patients with acne in Ontario, Canada.
        J. Am. Acad. Dermatol. 2006; 54: 331-335
      3. Central LHIN health service needs assessment and gap analysis.
        www.centrallhin.on.ca
        Date: 2008
        Date accessed: October 25, 2020
      4. Quality Ontario.
        • Arkema E.V.
        • Grunewald J.
        • Kullberg S.
        • Eklund A.
        • Askling J.
        Sarcoidosis incidence and prevalence: a nationwide register-based assessment in Sweden.
        Eur. Respir. J. 2016; 48: 1690-1699
        • Evans M.
        • Sharma O.
        • LaBree L.
        • Smith R.E.
        • Rao N.A.
        Differences in clinical findings between Caucasians and African American with biopsy-proven sarcoidosis.
        Ophthalmology. 2007; 114: 325-333