Considering retinal detachments and predictors of poor visual outcomes after repair

Sally S. Ong, MD, Atrium Health Wake Forest Baptist, sat down with Sheryl Stevenson, Group Editorial Director – Eye Care, to discuss the key takeaways from her presentation, "Predictors of Poor Visual Outcome After Repair of Uncomplicated Rhegmatogenous Retinal Detachments," at the 11th Annual Vit-Buckle Society meeting, April 13 to 15, in Las Vegas, Nevada.

Video transcript

Editor’s note: This transcript has been edited for clarity.

Sheryl Stevenson: We're joined today by Dr. Sally Ong, who will be presenting at this year's Vit-Buckle Society meeting. Welcome, Dr. Ong. We'd love to learn more about your presentation this year regarding retinal detachments and predictors for poor visual outcomes.

Sally S. Ong, MD: Yes, thank you, Sheryl. Thanks for having me. In this retrospective cohort study, we examined baseline operative and postoperative characteristics that influence best-corrected visual acuity outcomes at 1 year in patients who underwent repair of uncomplicated rhegmatogenous retinal attachments at the Wilmer Eye Institute. In a previous publication in Eye last year, our group had shown that single-surgery anatomic success was highly associated with postoperative visual acuity outcomes for all surgical groups, including vitrectomy, scleral buckling alone, and combined vitrectomy buckling.

As a next step, we wanted to know what other factors influence visual acuity outcomes of the repair of rhegmatogenous retinal detachments. In this particular study, we included 808 eyes from 772 patients who had undergone repair of uncomplicated rhegmatogenous retinal detachments at the Wilmer Eye Institute between 2008 and 2018, and who had at least 1 year of follow up. Since baseline visual acuity was highly associated with foveal involvement and with 1 year visual acuity, it was controlled for in our univariate analysis. We found that after controlling for baseline visual acuity factors associated with visual acuity at 1 year included ADI [area deprivation index] national rank; ADI state rank; history of trauma; extent of detachment; type of primary surgery; use of perfluorocarbon liquids; drainage retinotomy; time from presentation to surgical repair; single-surgery anatomic success; choroidal detachment after surgery; presence of cystoid macular edema after surgery; and lens status at 1 year.

Next we did multivariate analysis. In multivariate analysis after removing nonsignificant variables one at a time, we found that characteristics that remain associated with visual acuity at 1 year included visual acuity at baseline; type of primary surgery; ADInational rank; time from presentation to primary repair; single-surgery anatomic success; presence of cystoid macular edema after surgery; and lens status at 1 year. Most of these factors have actually previously been reported to be associated with postoperative visual outcomes of the repair of rhegmatogenous retinal detachments.

To the best of our knowledge, this is the first time that national ADI scores have been associated with these postoperative visual key outcomes. The area deprivation index, or ADI, allows for rankings of neighborhoods by socioeconomic disadvantage in the region of interest. It includes factors for the theoretical domains of income, education, employment, and housing quality. The higher the ADI scores, the greater the amount of socioeconomic disadvantage.

In our cohorts, groups with higher ADI scores had worse visual acuity outcomes at 1 year, and groups also included African Americans compared with other races; patients with no insurance; followed by those with public and then private insurance; patients with a history of trauma; patients with worse presenting baseline visual acuity; patients with longer time between presentation to surgical repair, in particular those with foveal involving detachments; patients who presented with foveal involving detachments; and greater extent of detachment.

Interestingly, even though single-surgery anatomic success was not different between patients across different ADI scores, patients with higher ADI scores after multivariate analysis had worse best-corrected visual acuity at 1 year follow up. Last year, actually in a separate manuscript that our group published in the Journal of Ophthalmic Inflammation and Infection...we showed that patients with higher ADI scores have worst visual acuity outcomes after repaired retinal attachments that were associated with viral retinitis, so a different group of patients with retinal detachments, those with viral retinitis.

I think this really... Our findings and those findings highlight the importance that clinicians be aware of the socioeconomic factors that may influence their patients' functional outcomes. It may be important for physicians and their teams to be aware and try to accommodate patients who have socioeconomic challenges like having access to phones to make appointments, getting time off from work to come for their appointments, and transportation is sometimes a huge barrier for patients with socioeconomic disadvantage, health awareness, and other factors.

Stevenson: What are the key takeaways that clinicians can put into use right away on Monday morning when they return to their practice?

Ong: Yeah, that's a great question, Sheryl. The takeaway message from this study is that patients who come to our clinic, in addition to seeing their pathology and what we find from our exam, clinical exam, we also have to think about factors that are beyond what we see immediately in front of us. Factors like socioeconomic barriers that patients may face. They may influence ultimately how timely they can get their surgery, how quickly their surgery will be approved by insurance or if they have no insurance how do we cover for that, and just the stresses that patients have to be able to come to their appointments on time, to get their postoperative drops on time.

A lot of different factors that may not be so obvious in the beginning, but if you really look into the socioeconomic factors, I think those are some of the other ways that we may be able to help our patients achieve the best outcomes that they can get.