Temporal Trends and Regional Variations in Retinal Detachment Repair Procedures in the United States

Purpose: To describe whether monitoring shifts in practice patterns and reimbursements for retinal detachment (RD), a sight-threatening condition requiring prompt treatment, can improve patient outcomes and optimize healthcare resource allocation. Methods: This cross-sectional population-based study evaluated trends and geographic variations in RD repair procedures using US Medicare fee-for-service provider utilization and payment Part B data from 2013 to 2021. Our analysis used Current Procedural Terminology codes for pars plana vitrectomy (PPV), complex repair, scleral buckling, pneumatic retinopexy, photocoagulation, and cryotherapy. We also included an examination of changes in insurance reimbursement. Results: Between 2013 and 2019, we observed a significant, 7.3% increase in the total number of procedures. However, in 2020, the COVID-19 pandemic led to an 11.1% decline in procedures, with an incomplete recovery in 2021. While use of other procedures declined, PPV and complex repair were the most common across geographic regions, showing rising trends over time. The average Medicare reimbursement for RD repairs dropped by 29%, with cryotherapy facing the largest reduction. Female ophthalmologists received significantly lower average standardized Medicare reimbursements for PPV (adjusted mean difference, $81.90; 95% CI, 48-115.80; P < .001) and complex repair (adjusted mean difference, $218.30; 95% CI, 156-280.70; P < .001) and higher reimbursements for pneumatic retinopexy procedures (adjusted mean difference, $13.80; 95% CI, 3.50-24.20; P = .009) after adjusting for confounders. Conclusions: PPV has become the predominant procedure among Medicare beneficiaries across geographic regions. Decreasing reimbursements, the COVID-19 pandemic, and patient- and surgeon-related factors influence these trends in RD repair. Significant reimbursement disparities between male and female ophthalmologists for pneumatic retinopexy, PPV, and complex repair procedures have also been identified.