Demographic Variations in Presentation, Treatment, and Outcomes in Patients With Rhegmatogenous Retinal Detachments

Purpose: To assess the relationships between social determinants of health and presentation, management, and visual outcomes in patients with rhegmatogenous retinal detachment (RRD). Methods: This cohort study included 347 patients who underwent RRD repair at a large academic center between 2012 and 2019. Demographic data, baseline RRD features, repair method, and visual outcomes were collected via chart review. The Centers for Disease Control and Prevention's 2022 Social Vulnerability Index provided a numeric estimate of social vulnerability. Results: Compared with White patients, Black patients had worse preoperative logMAR visual acuity (VA; mean logMAR difference, 0.57; 95% CI, 0.002-1.13; P = .05) and final VA (mean logMAR difference, 0.60; 95% CI, 0.14-1.06; P = .01). Individuals with government insurance had higher odds of having a longer duration of detachment (adjusted odds ratio, 2.66; 95% CI, 1.21-5.81; P = .01). Worse VA was seen in those with government insurance vs private insurance at the preoperative (mean logMAR difference, 0.47; 95% CI, 0.12-0.82; P = .009) and final timepoints (mean logMAR difference, 0.43; 95% CI, 0.14-0.71; P = .004). Older age was predictive of better logMAR VA by the final timepoint (β = 0.01; 95% CI, -0.02 to 0.001; P = .06). Conclusions: Baseline and final VA differed across ethnicity and insurance type, with worse outcomes in Black patients and individuals with government insurance. Further research and policy changes are needed to ultimately reduce RRD disparities.