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Experts say there are a number of factors that may explain why Black and Hispanic patients have less successful outcomes after retinal detachment surgery. Maskot/Getty Images
  • Researchers investigated whether race is a factor in vision outcomes following surgical treatment for retinal detachment.
  • They reported that Black and/or Hispanic patients tended to have worse vision following surgery than white patients.
  • Experts say further research is needed to confirm the results.

Retinal detachment is an eye condition in which the retina – a light-sensitive tissue layer at the back of the eye – is pulled away from its normal position. The condition is often caused by aging or injury.

The most common type of retinal detachment is rhegmatogenous retinal detachment (RRD), which happens when a small tear or break occurs in the retina. Surgery is the most common treatment for this condition.

However, studies show that non-white patients have lower success rates following surgery and worse visual outcomes than white patients.

Experts say that understanding more about why non-white patients have less successful surgical outcomes could improve treatments.

Recently, researchers compared the vision outcomes of Black, Hispanic, and white patients who underwent surgery for retinal detachment.

They found that Black and Hispanic patients had worse vision results than white patients.

The study was published in the Canadian Journal of Ophthalmology.

For the study, the researchers compared medical records from 124 Black and/or Hispanic participants and 71 white participants diagnosed with RRD.

All underwent surgical treatment at Boston Medical Center.

Black and Hispanic participants were an average age of 50 years old, whereas white participants were an average of 57 years old.

Whereas 65% of Black and Hispanic participants had multiple retinal breaks, the same was true for only 49% of white participants.

Black and Hispanic patients were also more likely to have proliferative vitreoretinopathy (PVR), the most common cause of failure of RRD surgery. With PVR, the formation of scar tissue interrupts normal healing after the surgery, causing redetachment of the retina.

The patients’ visual outcomes were measured at 6 months and at final follow-up.

Although both groups presented similar vision before surgery, the researchers noted that Black and Hispanic participants had worse postoperative vision than white patients at 6 months and at 2 years.

In the study, the authors noted that a higher presence of PVR among Black and/or Hispanic participants prior to surgery likely contributed to worse vision outcomes.

When asked about other factors that might influence worse vision results among Black and/or Hispanic patients, Karen Lincoln, PhD, a professor of environmental and occupational health at the University of California Irvine who was not involved in the study, told Medical News Today:

“One factor that might explain racial differences in vision results is related to access to vision care for minority populations across the lifespan. Under-diagnosis and under-treatment in the form of fewer ocular diagnoses, less access to and utilization of vision care, and lower rates of follow-up care contribute to observed racial and ethnic differences in treatment outcomes. The ability to afford glasses is linked to socioeconomic status and, unfortunately, many families have to make difficult choices about how to use limited resources.”

“Black children and adolescents have the highest per capita rate of blindness and visual impairment of all racial groups of the same age,” Lincoln added. “And we cannot underestimate the excessive burden that many Black adults experience due to diabetes and diabetic retinopathy compared to other racial and ethnic groups. So, it’s important to consider social determinants of health, the lifespan and the cumulative effects of under-diagnosis and under-treatment to understand health disparities.”

Dr. Noy Ashkenazy, an assistant professor in the Department of Ophthalmology at UT Southwestern Medical Center in Texas who was also not involved in the study, added that genetic factors linked to inflammation and scar tissue formation may also play a role in the different outcomes between patients of different ethnicities.

Ashkenazy explained: “The study was retrospective and excluded patients who did not self-report their race and/or ethnicity, which may have introduced sampling bias. Sample size may have limited statistically significant racial differences in outcomes, such as final surgery success rate,” Ashkenazy told MNT.

Lincoln added that another limitation is that the Black and Hispanic participants had different characteristics than the white patients- they were younger and more likely to have more than one retinal break or PVR. She noted that these differences might indicate a longer history of vision problems than among non-white participants.

“Because of the dearth of studies focused on African Americans specifically, there might even be delayed presentation or less common indicators of vision problems such as sickle cell retinopathy that are more common in African Americans but were not considered in this study,” she said. “We must also be cognizant of the important impact of health literacy levels, in particular, the ability to recognize symptoms of eye problems, which can result in delayed care and advanced presentation. All of these factors should be considered when interpreting results.”

“As a retina surgeon, it is helpful to have data showing that the demographic information of a patient may impact their potential visual gain after a successful retinal reattachment surgery,” said Ashkanazy. “As a community, we should truly strive to elucidate these risk factors further so that we can improve outcomes in our minority patients.”

MNT also spoke with Dr. Jeff Dello Russo, an ophthalmologist and eye surgeon in New York who was not involved in the study. He noted that the findings run contrary to what he has seen in practice, in which most patients with RRD are Caucasian men.

Dello Russo indicated that socioeconomic factors might be important for understanding outcome disparities.

“If the study is looking at cross sections throughout the USA, of course, lower income and less education and poor access to eye care will have worse outcomes. But here in the N.Y. metro Area, in general, all income groups can find good urgent eye care through most of our ERs,” he concluded.