New research based on a data analysis from the American Academy of Ophthalmlogy’s AAO) Intelligent Research in Sight (IRIS Registry) sought to determine how long it would take for delayed retinal pathology to manifest in the eyes following an initial diagnosis of acute posterior vitreous detachment (PVD).
Talk about patient enrollment first.
Investigators selected adult patients (>18 years of age) who were documented in the IRIS Registry with PVD from July 2013 to December 2018, with common procedural technology (CPT) codes of extended ophthalmology, and with eyes that had no retinal break or detachment.
In total, 424,046 eyes (mean age of 70 years) met the inclusion/exclusion criteria; of that, 10,518 eyes presented with a delayed retinal break (median of 42 days) or detachment (median of 51 days) following initial PVD.
Now tell me about the study.
The non-randomized retrospective cohort study examined ocular baseline characteristics that included:
- Presenting visual acuity (VA)
- Lens status
- Laterality
- Presence / absence of vitreous hemorrhage
- Myopia, history of retinal break and / or detachment in the fellow eye
- Lattice degeneration.
Other baseline characteristics included: patient age, sex race/ethnicity, smoking status, insurance, subspecialty of the treating physician, and practice location.
How did they measure outcomes?
The investigators constructed a multivariable shared frailty survival model to examine risk factors for delayed retinal break / detachment within 1 year of initial PVD diagnosis.
The primary outcome was the length of time (days) to a delayed or missed retinal break or detachment following an initial PVD (classified by the physician’s level of specialty care; non-retina vs retina specialist).
Secondary outcomes included the number of delayed/missed retinal breaks or detachments within 1 year after the study began as well as the final VA nearest to 1 year following the start (+/- 3 months).
Findings?
For eyes with at least one ocular risk factor (14.2%), the median time to a retinal break was shortened to 34 (retinal break) and 39 (retinal detachment) days.
For eyes with only a vitreous hemorrhage, the retinal break median time was 14 days,
Anything else significant?
The investigators noted a statistically significant difference for delayed retinal detachment timing among non-retina specialists (median = 57 days) and retina specialists (median = 46 days).
However, eyes with a delayed retinal break did not experience a significant difference among the subset (median = 38 days).
How about limitations?
Notable restraints included potential inaccuracies of the IRIS Registry data, leading to inaccurate patient exclusion or inclusion, and the diagnosis of PVD being limited to the registry’s coding and, as a result, unverifiable
Others included the severity of certain conditions that were unavailable within the data—such as severity of vitreous hemorrhage, degree of lattice degeneration and myopia, and the number of retinal tears diagnosed.
Take away.
The authors concluded that the timing of a follow-up exam following an initial PVD diagnosis is critical for detecting potential delayed retinal pathology.
Further, they recommended for all patients to have at least one repeat exam within 6 weeks; more than one may be needed (and sooner) within the first month for those with higher risk characteristics.