Rhegmatogenous retinal detachment (RRD) repair decisions are influenced mainly by patient- and physician-level factors and less by geographic variation, a study in Ophthalmology reports.      

Researchers evaluated the influence of patient characteristics, physician practice and geographic region on treatment variation for primary RRD in this retrospective claims-based analysis. The study included 12,779 commercially insured patients with incident rhegmatogenous retinal detachment diagnosed between 2008 and 2016.

The study determined whether patients underwent primary RRD repair within 60 days of diagnosis and identified the type of repair performed. Investigators found the majority of incident rhegmatogenous retinal detachment patients received treatment within the two-month window.

Investigators found pars plana vitrectomy was the most common procedure performed (49%), followed by laser barricade (23%), scleral buckle and pneumatic retinopexy (both 11%) and cryotherapy (5%).

Physician-level variation had greater impact on receipt of any treatment compared with geographic-level variation. Patient-level characteristics represented approximately 82% of overall variation in receipt of any repair vs. 16% from physician-level and just 2% from geographic-level factors. Physician-level factors represented approximately 50% of total variation in repair type, followed by patient-level (49%) and geographic-level factors (1%).

“Patient characteristics account for most of the variation in receipt of repair, and physician practice accounts for most of the variation in choice of procedure,” researchers noted in their paper. “These findings indicate a need for additional studies to understand drivers behind differences in care and clinical outcomes and to identify barriers in access to care.”

Vail D, Pershing S, Reeves MG, et al. The relative impact of patient, physician, and geographic factors on variation in primary rhegmatogenous retinal detachment management. Ophthalmology. April 12, 2019. [Epub ahead of print].