Studies have shown that rhegmatogenous retinal detachment (RRD) benefits from early intervention and that delays in treatment can result in poor outcomes. Although RRD is an urgent medical condition, numerous factors can cause a delay in the pursuit of treatment.

Assessing the RRD–Vaccine Hesitancy Correlation

Evidence also suggests a correlation between worsening emergent eye diseases and delay or refusal of COVID-19 vaccination. Peter Tang, MD, PhD, and colleagues sought to explore this correlation with worsening RRD. “It has been observed that patients who demonstrate vaccine hesitancy are presenting with worsening eye disease,” adds Dr. Tang.

For a paper published in the American Journal of Ophthalmology, Dr. Tang and colleagues conducted a single-center, clinical cohort study to evaluate and describe COVID-19 vaccine hesitancy and/or resistance and the resulting clinical trends and outcomes for RRD. The 1,047 patients with RRD who were included in the study were divided into three cohorts based on vaccination status, with vaccination defined as receiving a single dose of the Johnson & Johnson vaccine or at least one dose of either the Pfizer or Moderna vaccine:

  1. Prior-vax cohort: 391 patients vaccinated prior to their initial presentation of RRD
  2. Later-vax cohort: 252 patients were subsequently vaccinated after their initial presentation of RRD.
  3. Never-vax cohort: 404 patients were unvaccinated throughout the study.

Initial Presentation

The primary outcome was the proportion of patients presenting with macula-off RRD. Secondary outcomes included best-corrected visual acuity (BCVA), primary proliferative vitreoretinopathy (PVR), proportion lost to follow-up, and distance traveled.

The prior-vax cohort showed significantly lower rates of initial presentation with macula-off (44.5%) compared with the later-vax (54%) and never-vax (57.9%) cohorts (P<0.0001). The presence of primary PVR was significantly greater (P<0.0001) in the later-vax (13.6%) and never-vax (17.1%) cohorts compared with the prior-vax cohort (4.3%).

Patients in the later-vax and never-vax cohorts presented significantly worse (P≤0.0006) in initial and final BCVA compared with the prior-vax cohort. There were, however, no significant differences in initial and final BCVA between later-vax and never-vax cohorts.

Combination scleral buckle and pars plana vitrectomy (SB/PPV) procedures were performed in 37.9% of never-vax patients, compared with 58.2% of later-vax and 66.7% of prior-vax patients (Figure). No statistically significant differences were observed in the rates of pneumatic retinopexy, primary SB, and primary PPV procedures performed across all three cohorts. More patients experienced retinal re-detachments following initial surgical repair in the later-vax (7.4%) and never-vax (13.5%) cohorts compared with the prior-vax (5.9%) cohort (P≤0.0112).

A significantly greater proportion of the never-vax cohort (7.7%; P<0.0001) did not return for their recommended 3-month follow-up compared with the prior-vax cohort (2.3%) and later-vax cohort (2.2%). Median travel distance for treatment was farther for patients in the never-vax cohort (35 miles; P≤0.0002) compared with the prior-vax (22.3 miles; P<0.0001) and later-vax cohorts (25.45 miles; P=0.0038).

Think Outside the Box

Dr. Tang encourages ophthalmologists to “be aware of issues/situations outside of the eye that can inform clinical suspicion for treating these devastating eye diseases,” adding that “it would be interesting to see how patients’ political affiliations may influence disease presentation. This is very similar to previous research with which smoking history was indicative of worse diseases, like hypertension, and medical non-compliance.”

​Dr. Tang also reminds clinicians “that sometimes you need to think outside the box in order to understand patient risk factors.”