Findings from a recent study published in Ophthalmology Retina found that patients with atopic dermatitis (AD) face substantially elevated risks of retinal detachment (RD) and worse postoperative outcomes compared to matched controls.
The signal showed up in both population-level diagnosis rates and post-repair complications, pointing to AD as an underrecognized factor in retinal disease.
Give me some background first.
AD, commonly called eczema, is a chronic inflammatory skin condition that affects roughly 7.6% of US adults. Once considered a localized dermatologic issue, it is now understood as a systemic disorder tied to immune dysregulation and chronic inflammation.
Why that matters: Ocular comorbidities in AD patients have been documented for years, with frequent eye rubbing previously linked to RD in this population.
But whether AD raises RD risk at a population level, and whether it worsens surgical outcomes after repair, hadn’t been quantified in a large U.S. cohort.
Now, talk about the study.
Researchers at the Keck School of Medicine of the University of Southern California ran a retrospective, population-based cohort study using the TriNetX U.S. Collaborative Network, a federated platform with de-identified electronic health record (EHR) data from more than 127 million patients across 72 US healthcare organizations.
The team ran two analyses:
- Risk of RD diagnosis and RD repair after an initial AD diagnosis or outpatient clinic visit
- Risk of postoperative proliferative vitreoretinopathy (PVR) and complex RD repair after an initial RD repair
Patients were matched 1:1 by propensity score, balancing demographic characteristics, ocular comorbidities, tobacco use, and systemic corticosteroid exposure.
Who was included in the study?
Adults aged ≥18 years with and without an AD diagnosis were identified using International Classification of Diseases (ICD)-10 codes from March 2006 to March 2026.
Cohort sizes: 285,408 patients with a history of AD and 2,856,666 without were identified.
- After propensity score matching (PSM), 274,547 remained in each cohort.
Demographics: Mean age was 49 years, 63% female, 62% White, 20% Black or African American, 10% Hispanic or Latino, 6% Asian.
Worth noting: Before matching, the AD cohort had markedly higher systemic corticosteroid use (69% vs 37%), one of the variables PSM was used to balance.
And the findings?
At 5 years, patients with AD had a higher rate of RD diagnosis (0.7% vs 0.2%; hazard ratio [HR] 2.74, 95% confidence interval [CI] 2.50 to 3.00; P<0.0001) and a higher rate of RD repair (0.2% vs 0.04%; HR 4.56, 95% CI 3.76 to 5.57; P<0.0001).
Tell me more.
Among patients who went through an initial RD repair (n=1,689 per cohort), the AD group had worse postoperative outcomes at 6 months:
- PVR diagnosis: 5.9% vs 4.0% (HR 1.45, 95% CI 1.12 to 1.87; P=0.002)
- Complex RD repair (CPT 67113): 8.9% vs 6.6% (HR 1.36, 95% CI 1.10 to 1.62; P=0.002)
So the risk extended past the initial detachment. RD repairs in AD patients were more likely to be complicated by PVR or to require complex surgical intervention.
Any limitations?
The data are retrospective and pulled from EHR codes, which carries the usual coding accuracy and misclassification concerns.
One important caveat: EHR data could not confirm whether postoperative PVR occurred specifically in the operative eye, which limits the strength of the postoperative analysis.
Causation also couldn’t be established. While PSM balanced corticosteroid use and key comorbidities, residual confounding from unmeasured behavioral factors like eye rubbing remained possible.
Expert opinion?
The authors argued that AD likely predisposes patients to RD and contributes to worse surgical outcomes, framing the condition as an under-recognized risk factor in eye care.
Anything else?
The mechanism question is still open. The authors pointed to two possible drivers:
- Chronic inflammation tied to AD that may affect retinal tissue
- Frequent eye rubbing among patients with itchy periocular skin
Also of interest: Whether enhanced eye screening or earlier referral would change outcomes for chronic AD patients is something prospective studies will need to sort out.
Take home.
For clinicians: AD patients warrant a lower threshold for RD evaluation when they present with new visual symptoms.
As such: For those who do undergo RD repair, closer postoperative monitoring is reasonable given the elevated risk of PVR and the higher likelihood of needing a complex repair.