Abstract
Purpose :
Rhegmatogenous retinal detachment (RRD) often requires urgent surgery to restore vision.Studies have found variation in RRD presentation and outcomes by age,gender,race,and income.However,the impact of patients’ residential location on RRD severity remains unclear.
Methods :
Retrospective chart review of adult patients who underwent an RRD repair at Cole Eye Institute from 2012 to 2020.Patients were excluded for previous penetrating trauma, posterior intraocular segment surgery to the presenting eye, or outliers in travel distance above 95th percentile.Demographic differences were characterized. Google Maps was used to calculate the travel distance in miles from the residential zip code to the presenting and surgery location addresses.Multivariable logistic and univariable linear regressions were used to compare macula-off status and Best Visual Acuity (BVA) in ETDRS letters at presentation and 6-month follow-up with patient travel distance by tertile or continuously.
Results :
1063 patients were identified for the study. Demographics and baseline ocular characteristics are shown in Table 1.Average distance to the presenting location was 25.22 mi and to the surgery location was 31.38 mi.Average (SD) BVA at 6-month follow-up for patients with data available was 60.96 (23.36),n=705.The reattachment rate was 95.8% for closest tertile, 96.3% for second tertile, and 94.9% for furthest tertile (p=0.66).In multivariable analysis including age,race,gender,ethnicity,median household income,insurance,and smoking status,distance tertile to presenting location was not predictive of macula-off status (OR 0.9978,95% CI 0.992,1.003,p=.25,n= 1061) or BVA at follow-up (first tertile 0.19 letters more than third tertile,95% CI -2.68,3.06,p=.896,n= 690).A subset analysis of patients with median household income less than$25,000 revealed that further distance to surgical location was associated with longer time to surgery (0.69 days longer per mile of distance, 95% CI 0.41,0.97,p<.0001,n=28),but was not associated with BVA at follow-up (-0.13 letters,95% CI -0.51,0.24,p=.25,n=21).
Conclusions :
Further distance is significantly associated with a delay in time from diagnosis to surgery for low-income patients, but distance does not impact macula-off status or BVA at follow-up. This suggests that patients who are further from the hospital may be able to achieve equivalent outcomes from RRD repair, despite delays in surgery.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.