Abstract
Purpose :
Long travel distance in underserved areas such as rural North Dakota could delay treatment of rhegmatogenous retinal detachment (RRD). We performed a retrospective study to determine if patients living remotely to the vitreoretinal surgeon (VRS) experienced a delay in treatment, presented with more advanced RRD, or had worse visual acuity (VA) outcomes than patients living locally.
Methods :
Medical records were reviewed of 143 patients who underwent repair of primary RRD by pars plana vitrectomy or scleral buckle by a single VRS from Aug. 2011 to Sept. 2014 in Minot, North Dakota. Exclusion criteria were RRD associated with penetrating globe injury, endophthalmitis, or previous PPV. Data recorded from the medical record included distance traveled to the VRS, time from referring provider exam to the VRS exam, extent of RRD, time from VRS exam to surgery, pre and postoperative VA, and reoperation rate. The main outcome measure was mean logMAR VA change at 6 months. All statistical tests were two-tailed with p<0.05 considered significant. The Institutional Review Board of Trinity Health approved this study.
Results :
Of the 143 total patients, 45 lived locally, 5.2±1.6 miles and 98 lived remotely, 122.8±69 miles. Time from referring provider exam to VRS exam was similar for local and remote patients, 1.5±2.9 vs. 1.5±2.8 days (p=.97). Mean preoperative VA was 20/135 local vs. 20/178 remote. The fovea was detached in 51% local compared to 53% remote (p=.78). Clock hours of RRD were similar in local and remote patients, 5.2±2.3 vs. 5.5±2.6 hours (p=.51). Time from VRS exam to surgery showed no difference, 1.8±3.4 vs. 1.8±3.8 days (p=.70). Mean VA at 6 months was 20/39 local vs. 20/51 remote. The mean logMAR VA change at 6 months was similar in local and remote patients, -.54±.7 vs. -0.52±.8 (p=.91). At 6 months VA≥20/40 was achieved in 67% locally compared to 70% remotely (p=.78). 6 month anatomic success rate was 100% in both groups. Retained silicone oil was present 4% local vs.7% remote (p=.54). Reoperation was required in 4% local vs. 6% remote (p=.69).
Conclusions :
Patients with long distance travel to the VRS for management of RRD did not experience a delay in treatment, present with more advanced RRD, or have worse VA outcomes than patients who lived locally. Patients with RRD in rural areas remote from a VRS can have equivalent outcomes to those living near a VRS when referred and treated urgently.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.