Women less likely than men to receive retinal detachment repair

Women are 34% less likely to receive a repair for a retinal detachment compared with men, according to an abstract presented during the 2020 Virtual Retina Society annual meeting (Abstract 1455).

Differences between men and women in the diagnosis, timing, and treatment of diseases and conditions have been documented in multiple medical disciplines over the years, with women experiencing increased morbidity and mortality as a result, particularly in cardiology. Data presented by Natalia Callaway, MD, MS, Byers Eye Institute at the Stanford University School of Medicine, suggests that ophthalmology may not be immune to gender disparities in care. 

Study Design and Results

Retinal detachments are a serious ophthalmic diagnosis and can result in blindness if left untreated. Timely repair is vital to save vision and avoid permanent disability. To assess if there were differences between the sexes in the repair of this grave ophthalmologic emergency, Dr. Callaway and colleagues examined about 61,000 cases of new rhegmatogenous retinal detachments, 23,933 that were included in the primary analysis, between 2007 and 2015 from the largest insurance claims database in the United States spanning over 133 million records during the study period and estimated to represent about 50% of the insured working population in the US. A total of 43% of those cases (~26,000) were women with an overall retinal detachment repair rate of 93%.

The primary outcome was the receipt of surgical intervention for a retinal detachment. Secondary outcomes were time to repair, the type of intervention, and the rate of reoperation by sex.

“We found across all models, including our primary model and our sensitivity models, [that] women had lower odds of receiving retinal detachment repair after adjusting for available confounders,” Dr. Callaway said. “Extrapolating the results presented here to the United States Census data for the applicable population covered by this type of insurance, based on our study results, if the odds of repair of retinal detachment between men and women were equal, then 7,029 more women would receive surgery during the study period.”

Women who received repair were more often delayed as well, but the delay was minimal (less than 1 day [0.17 days; p=0.04]) and likely not clinically significant the authors concluded. Interestingly, women were more likely to undergo different types of repair for retinal detachment, including primary laser barricade, primary scleral buckle, or pneumatic retinopexy, compared with men who were more likely to undergo pars plana vitrectomy. The odds of reoperation, however, were lower in women than men.

When it comes to explaining the reasons for the sex differences in retinal detachment treatment, the researchers could not pin down one specific cause from this study alone. Dr. Callaway said men and women are known to have different rates of trauma and retinal detachment, as one example. Biology could be another factor, in that the sexes may present with different types and configurations of retinal detachment that result in the differences in surgical repair.

However, biological differences do not explain the lower odds of surgical repair. Social differences likely play a role in the primary study finding, she said.

“Women are more often caregivers at every stage of life, and this carries significant informal responsibility that may limit their access to care,” Dr. Callaway said. “Women may also be less likely to voice concerns or challenge authority. Women are more likely to be widowed, live under the poverty line, and they may not have the support to travel to numerous appointments or access to the required medications.” Dr. Callaway acknowledged there are limitations to claims data that is important to consider when evaluating these results and that there may be other important confounders that could not be assessed in this study including race, socioeconomic status, and insurance coverage levels.

In order to understand potential disparities in the healthcare field, additional research must be done to identify the problem, she urged. In particular, Dr. Callaway recommended that further studies, ideally with visual acuity data, would be ideal to better understand this data.

“This study represents the first to focus on the differences in the receipt of intervention for this ophthalmic emergency and finds that insured women are less likely than insured men to receive surgical repair for a vision-threatening emergency after controlling for available confounders,” she said, adding the paper has recently been published in American Journal of Ophthalmology.

The authors have no relevant conflicts of interests or disclosures.