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Time to Treatment of Pediatric Retinal Detachments: A US Claims-based Analysis
Cyril Archambault1, Amee D Azad1, Ahmad Al-Moujahed1
1Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
Insights
Pediatric patients with retinal detachment (RD) often experience delays in diagnosis and treatment, especially those without prior eye conditions. Early detection and intervention are crucial for better outcomes in children with RD.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Health Services Research
Background:
- Retinal detachment (RD) is a significant cause of visual morbidity in children.
- Timely diagnosis and treatment are critical for preserving vision in pediatric patients.
Purpose of the Study:
- To investigate delays in the diagnosis and treatment of retinal detachments (RDs) in a pediatric population.
- To compare diagnosis and treatment timelines between pediatric RD patients with and without pre-existing ocular conditions.
Main Methods:
- Retrospective cohort study utilizing insurance claims data from a national cohort of commercially insured patients aged 18 years or younger.
- Analysis included patients diagnosed with RD between 2007 and 2016, calculating time to diagnosis and repair.
- Comparison of timelines based on the presence of preceding eye-related diagnoses.
Main Results:
- The majority of 826 pediatric patients had rhegmatogenous RD (77%).
- A significant proportion of patients (40%) had no preceding eye-related visits before RD diagnosis, with median times from last visit to diagnosis of 32 days.
- Patients with pre-existing ocular diagnoses had shorter median times to RD diagnosis (14.5 days vs. 44.5 days) and repair (1 day vs. 3 days) compared to those without.
Conclusions:
- Pediatric patients, particularly those without prior ocular diagnoses or visits, may face delays in RD diagnosis and treatment.
- These delays can potentially impact visual outcomes.
- Highlighting the need for increased awareness and timely referral for pediatric RD.
Purpose:
To characterize delays in diagnosis and treatment of retinal detachments (RDs) in a pediatric population.
Design:
Retrospective cohort study using insurance claims data.
Subjects:
Pediatric patients with RD who underwent repair in the outpatient setting.
Methods:
A retrospective analysis of commercially insured patients from a national cohort (IBM MarketScan Research Databases) aged ≤ 18 years with an incident diagnosis of RD between 2007 and 2016. Patients with preceding eye-related visits, time to diagnosis, and time to repair were calculated and compared between patients with pre-existing ocular diagnosis and those without.
Main Outcome Measures:
The time from diagnosis to specialist consultation, time from diagnosis to repair, time from specialist consultation to repair, number of preceding visits, and presence of previous eye-related diagnosis.
Results:
Our sample consisted of 826 patients, the majority (77%) of whom were diagnosed with rhegmatogenous RD. Only 40% of patients had at least 1 preceding eye-related visit, and 33% had at least 2 visits before RD diagnosis, with a median time from the last eye-related visit of 32 days (4-197 days) and median time from the second to last visit of 118 days (24-437 days). The median time from RD diagnosis to repair was 2 days (0-9 days). The 323 (37.9%) patients with pre-existing ocular diagnoses more frequently had at least 1 (44% vs. 37%; P = 0.079) or 2 preceding eye-related visits (40% vs. 29%; P = 0.002) compared with those without and also had a shorter time to RD diagnosis (median, 14.5 days vs. 44.5 days; P = 0.011) and repair (1 day vs. 3 days; P = 0.003).
Conclusions:
Retinal detachment is an important cause of morbidity in children. This work highlighted how pediatric patients without previous ocular diagnoses and visits with eye care professional may have a delayed diagnosis and repair of their RD.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found after the references.
