Purpose
Few studies have previously described the epidemiology and risk factors associated with macular holes (MH). Identifying risk factors associated with MHs may lead to a better understanding of the pathophysiology of this condition.
Methods
All individuals age ≥40 who were enrolled in a large US managed care network during 2001-2012 with no pre-existing history of MH or MH surgery, were followed longitudinally to assess for the development of a MH (ICD-9-CM code 362.54). Survival analysis was performed using a Cox proportional hazard regression modelling to identify sociodemographic factors, ocular comorbidities, and systemic medical conditions associated with the development of MH.
Results
Among the 559,793 eligible individuals in the plan, 2687 (0.48%) developed a MH. After adjusting for potential confounding variables, the hazard of developing MH increased with age (HR, 1.04 [95% CI, 1.03-1.04]), female gender (HR, 1.08 [CI, 0.99-1.16]), Asian American race, (HR, 1.48 [CI, 1.19-1.84). There was no significant difference in the risk of MH among blacks or Latinos compared with non-Hispanic whites (p>0.05). Patients with diabetic retinopathy had an increased hazard of MH (HR, 2.70 [CI, 2.24-3.25]), as well as those with uveitis (HR, 1.77 [CI, 1.51-2.08]), and patients who were pseudophakic/aphakic (HR, 1.87 [CI, 1.71-2.05]).
Conclusions
This is the largest study we are aware of assessing the incidence and risk factors for MHs. Further research is needed to confirm the clinical basis for these risk factors.