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Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency.

André S Pollmann1, Ashlyn M Pinto1, Danielle Cadieux1

  • 1Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and.

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Rural residency in Atlantic Canada did not impact Descemet stripping automated endothelial keratoplasty (DSAEK) graft failure. Repeat corneal surgery was linked to shorter travel times, not rural status, highlighting potential access barriers.

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Area of Science:

  • Ophthalmology
  • Public Health
  • Health Services Research

Background:

  • Rural populations face challenges accessing specialized healthcare services.
  • Geographic location can influence the indications and outcomes of ophthalmic procedures.
  • Understanding these disparities is crucial for equitable healthcare delivery.

Purpose of the Study:

  • To investigate the effect of rural and small town (RST) residence on the indications and outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in Atlantic Canada.
  • To determine if rurality impacts the need for repeat keratoplasty or graft failure after DSAEK.
  • To assess the relationship between travel time, rural residency, and DSAEK outcomes.

Main Methods:

  • Retrospective cohort analysis of DSAEK procedures performed in Nova Scotia (2017-2020).
  • Patient rurality classified using the Statistics Canada Statistical Area Classification system.
  • Logistic regression models analyzed factors associated with DSAEK indication and outcomes, including repeat procedures and graft failure.

Main Results:

  • 32.1% of DSAEK procedures were performed on rural or small town residents.
  • Rural residency was not significantly associated with repeat keratoplasty or graft failure.
  • Increased travel time was associated with a higher likelihood of undergoing DSAEK for a previous failed keratoplasty.

Conclusions:

  • Rural residence in Atlantic Canada is not a predictor of DSAEK graft failure.
  • Shorter travel times, not rurality, were associated with repeat endothelial keratoplasty, suggesting access challenges.
  • Findings emphasize the need for regional health strategies to improve access to ophthalmology subspecialist care.