Socioeconomic and Demographic Factors Contributing to COVID-19–Related Delays and Reductions in Primary Retinal Detachment Repair in a US Hot Spot

Abstract

Purpose: This work evaluates demographic and socioeconomic predictors of delayed care for rhegmatogenous retinal detachments (RRDs) during the spring 2020 COVID-19 shutdown in a US hot spot. Methods: This multicenter, retrospective, case-control study took place in 3 academic vitreoretinal practices in metropolitan Boston. Consecutive patients treated for RRD during the COVID-19 state of emergency were compared with patients treated during the same period in 2018 and 2019. The primary outcome was macula status for RRD. Secondary outcomes included visual acuity, symptom duration, proportion with proliferative vitreoretinopathy, time to procedure, method of repair, and patient demographics. Results: The total number of acute RRD decreased by 13.7% from 2018 to 2020 and 17.2% from 2019 to 2020. Symptom duration was significantly longer in 2020 than 2018 and 2019 (median, 7 vs 4 days) with a higher proportion of macula-off detachments (80 of 125 [64%] in 2020 vs 75 of 145 [51.7%] in 2018 and 78 of 151 [51.6%] in 2019). The 2020 cohort included significantly fewer patients in the racial and/or ethnic minority group than in 2019 ( P = .02), and use of low-income, government-sponsored health insurance was a predictor of macula-off status during the pandemic ( P = .04). Conclusions: RRDs during the spring 2020 COVID-19 lockdown were more likely to be macula-off at presentation. Because sociodemographic factors including race, ethnicity, and income level were associated with deferral of care, ophthalmologists should consider measures targeting vulnerable populations to avoid preventable vision loss as the pandemic continues or in future health care emergencies.

Nationwide Demographic Disparities in United States Emergency Department Visits in Patients With Rhegmatogenous Retinal Detachment

“…One study demonstrated that low-income, government-sponsored health insurance was a predictor of macula-off RRD status during the 2020 COVID-19 pandemic. 13…”

“…Saraf et al 8 reported a higher prevalence of RRD among Whites compared with other races using the Intelligent Research in Sight Registry. Port et al 13 reported that non-Hispanic White race/ethnicity and those with income-level Medicaid or MassHealth (a state-sponsored insurance program for low income) were associated with deferral of care during the 2020 COVID-19 pandemic, resulting in more macula-off RRDs and significantly longer duration of symptoms. We found that Hispanics had the highest RRD ED incidence and Native Americans had the lowest.…”