ASRS 2024: Socioeconomic barriers and visual outcomes

Sally S. Ong, MD, spoke about her study on the impact of individual and neighborhood-level social determinants of health on vision and foveal status at presentation in patients with rhegmatogenous retinal detachments at the annual ASRS meeting in Stockholm, Sweden.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Sally S. Ong, MD:

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Sally S. Ong, MD:

Hi, my name is Dr. Sally Ong from the Atrium Health Wake Forest Baptist Hospital in Winston-Salem, North Carolina. In our study, we looked at the association between individual and neighborhood-level social determinants of health with visual acuity, as well as foveal status at presentation of rhegmatogenous retinal detachments that were repaired at the Wilmer Eye Institute over a 10 year period.

This was a retrospective cohort study that was done in adult patients. We mapped home addresses to social determinants of health and did multivariable logistic regression to look at associations between these social determinants of health as well as with vision and foveal status at presentation of rhegmatogenous retinal detachments. Specifically, we did this study because there has been reports of relationships between vision outcomes, with social determinants of health in other ophthalmic conditions such as cataract, glaucoma, diabetic retinopathy, and macular degeneration. But not much has been looked at in terms of retinal detachments. And we really wanted to see how social determinants of health can affect vision outcomes in retinal detachments.

What we found was that there is a relationship between older age with vision at presentation. Older age was associated with worse vision at presentation, worse than 20/40. Older age was also associated with foveal involvelment at presentation. There was no difference in sex between the groups. Race and ethnicity wise, there was an association with vision at presentation. Non-Hispanic Black patients at higher proportions presented with vision worse than 20/40 compared to Non-Hispanic White patients. In terms of insurance status, we also found that patients who have public insurance, higher proportions presented with vision worse than 20/40 compared to patients with private insurance. So that was on the individual level. And we accounted for the individual level characteristics; age, sex, and ethnicity, and insurance status. We looked at a multitude of neighborhood level social determinants of health. And we found associations with vision and foveal status at presentation with 3 social determinants of health. Specifically, the 3 are area deprivation index–number 1. Percentage of workers who drove to work–number 2. Third would be per capita income. And what we found was that, first of all, for every increase in area deprivation index, which really is a marker for more social economic deprivation, there was an increased predicted probability of presenting with vision worse than 20/40 as well as presenting with foveal involving rhegmatogenous retinal detachments.

Secondly, we found that for every percentage increase in workers who drove to work in the neighborhood, there was increased predictive probability of presenting with vision worse than 20/40 and also presenting with foveal involving retinal detachments.

Thirdly, we found that for every $1,000 increase in per capita income, there was a decrease in predicted probability of presenting with vision worse than 20/40. However, there was no relationship between per capita income and foveal status at presentation of retinal detachment.

So we think in summary, 3 big takeaways from our study was that–First of all, there is an association between socioeconomic deprivation, as reflected by the higher ADI scores with worse retinal detachments at presentation, as reflected by worse vision, and foveal involvement. And secondly, we found that for workers who lived in neighborhoods where a car is needed to drive to work, patients don't have cars in those neighborhoods. They might have challenges accessing health care, and that may be why they present later in disease with worse vision, as well as with foveal enlargement. We thought that was an interesting finding. So people who don't have cars, but live in neighborhoods where cars are required, may have challenges assessing health care. The third finding that we found in terms of the association between higher per capita income was less likelihood presenting with worse vision, but that not really having an association with foveal status. We think that may be a reflection of the fact that patients with higher per capita income are more likely to have cataract surgery. So we think that relationship might be confounded by higher rates of cataract surgery, since we didn't find an association between per capita income with foveal involvement at presentation.

So all in all, I think our study really highlights how important it is to first of all identify some of the socioeconomic barriers that patients may face in terms of accessing health care to allow them to present earlier in disease. Because we know that patients who present later in disease specifically in rhegmatogenous retinal detachments, they may face higher complication rates in terms of you know, developing proliferative vitreoretinopathy, which would decrease their single surgery, anatomic success. And put them on this pathway of needing repeat surgeries. Our findings really highlight how important it is to first of all identify those barriers in terms of health. And that may help us in the long run, really be able to speak to our public policymakers and help them design public policies that may be able to target this vulnerable populations to help them better access health care, so that they can really you know, present earlier in disease and have better health outcomes.