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Epidemiology of rhegmatogenous retinal detachment in commercially insured…
Epidemiology of rhegmatogenous retinal detachment in commercially insured myopes in the United States
Introduction
Rhegmatogenous retinal detachments (RRDs) are separations of the neurosensory retina from the retinal pigment epithelium that occur following a break in the retina.
an increase in axial length has effects on the posterior retina and can alter the structure of the anterior retina
A recent study by Willis et al. reported that nearly 4 percent of US adults have high myopia
hypothesized that the incidence rate of RRD is rising along with the rising prevalence of high myopia.
Knowledge of the absolute risk and incidence of RRDs is necessary for optometrists and ophthalmologists to prepare for the rising burden of myopia.
Materials and methods
Our study population consists of 123,637,719 commercially insured patients in the Merative™ Marketscan® Research Database10 from 2007 to 2016
excluded patients with non-continuous enrollment
excluded patients from our analysis if they carried any diagnosis of sickle cell, serous retinal detachment, tractional retinal detachment, chorioretinitis, ruptured globe, choroidal hemorrhage, retinoschisis, vitreous hemorrhage or pseudophakia
Patients were classified as having myopia or high myopia if they carried a relevant International Classification of Diseases diagnosis code (ICD 9 367.1, ICD 10 H52.1 for myopia and ICD 9 360.21, ICD 10 H44.2* for high myopia) at any point during their enrollment.
statistics
Confidence interval (CI) of the incidence rate was calculated based on the Poisson distribution and the Z test was used to examine the difference in the incidence of RRD incidence between the comparison groups
Cox proportional hazards models used to calculate the risk of RRD given age, gender, myopia, and high myopia diagnosis
Results
samples
Of 85,476,781 commercially insured patients who met inclusion and exclusion criteria, 52.9% were female
Average age at the beginning of coverage was 32.6 years
average age at diagnosis of RRD was 51.9 years
incidence rate
incidence rate of RRD ranged from 21.72 to 33.60 RRDs per 100,000 person-years from 2007 to 2016
The rate of myopia minimally declined
The rate of high myopia steadily increased
incidence rare in non-myopes
overall incidence rate of RRD was 25.27 RRDs per 100,000 person-years
Non-myopes had the lowest incidence rate of 22.44 RRDs per 100,000 person-years
myopes had an incidence rate of 67.51 RRDs per 100,000 person-years
high myopes had the highest incidence rate of 868.83 RRDs per 100,000 person-years.
Discussion
Myopia contributes significantly to the risk of RRD
3-fold higher incidence rate of RRDs in myopes as compared to non-myopes
39-fold higher incidence rate of RRDs in high myopes as compared to non-myopes
The known risk factors for RRD include older age, myopia/longer axial length, a history of trauma, vitreoretinal degenerations, male sex, and occupational lifting.
Prior studies report a difference in age distribution of RRDs between Western countries with a single peak in the fifth to sixth decade of life, and Eastern countries with a peak in the second decade of life
Understanding the epidemiology of RRDs in myopia and high myopia is critical for eye care providers to better monitor high risk populations
Further studies are needed to explore the pathophysiological root behind sex differences in predisposition to RRD