Research indicates that women are 34% less likely than men to receive surgical intervention for repair of a rhegmatogenous retinal detachments (RRDs) in the United States. We speculate there are both biological and societal factors that contribute to this disparity in such an ocular emergency. The primary outcome variable—receipt of retinal detachment repair—more likely represents societal barriers that prevent women from getting to the operating room.
Studies also show that women are more often caregivers, which carries a tremendous burden and may include sacrificing their own care for others’ sake. Women are also more likely to be single parents, living below the poverty line, or widowed and, therefore, may disproportionately lack resources like transportation to attend frequent post-operative visits or access medications. Psychology literature also reveals that women may be less likely to voice concerns or challenge authority relevant to surgical date scheduling with a male physician. Finally, we cannot exclude the possibility of provider bias.
Timely Repair Important for Retinal Detachment
In a study published in American Journal of Ophthalmology, my colleagues and I aimed to investigate differences between women and men in the repair of RRDs. Disparities in healthcare delivery and outcomes between women and men are documented in various medical fields. However, no studies have evaluated gender differences in vitreoretinal surgery.
Because retinal detachment is a potentially blinding ophthalmic emergency that can only be repaired with surgical intervention, timely repair is important for prognosis and ultimate vision outcome, which dramatically impacts a patient’s quality of life. Therefore, we recognize the importance of determining whether gender differences exist in the repair of retinal detachments.
The retrospective cohort study used the Truven Health MarketScan database, which contains administrative data from more than 150 million US beneficiaries across more than 350 insurance carriers. The data set represents roughly 50% of the US population covered by employer-sponsored insurance and includes beneficiaries from all 50 states.
We evaluated records with at least 1 year of data and at least 30 days of postoperative data to capture incident retinal detachments from 2007-2015. Data collected included demographics, comorbid ocular conditions associated with retinal detachment, systemic comorbidities, and surgical intervention type. The primary outcome was the receipt of retinal detachment repair surgery, and secondary outcomes were time to repair, type of repair, and reoperation rate.
Women & Men With Retinal Detachment May Present Differently
The study evaluated 133 million beneficiary records with 61,071 cases of incident RRD, among which 43% (n = 26,289) were women. The primary outcome model had 23,933 confirmed RRD cases, with a 93% retinal detachment repair rate. Women had 34% reduced odds of receiving surgical repair of an RRD after adjusting for confounders (Figure), and this effect held in all sensitivity models.
This study’s secondary findings revealed that women’s surgeries were more often delayed, although the result was not likely clinically significant. Interestingly, women’s retinal repairs were performed using different surgical techniques than men’s surgeries. This finding raises the possibility that women and men present with different types or stages of retinal detachment. Women were also less likely to undergo a second surgery.
It should be noted that claims data have inherent limitations that are important to consider when interpreting the results of this study. It’s important to note that we do not have visual acuity outcomes with which to compare results. If the odds of repair between men and women were equal in the US, based on the results of this study, we estimate from US Census Bureau data that 781 more women each year would receive surgery for this emergency condition, or 7,029 during the study period (Figure). Gender, racial, and socioeconomic disparities in healthcare delivery are increasingly reported and are of significant concern to the entire medical profession. Further investigation in ophthalmology and other fields is required to deliver optimal healthcare outcomes to our diverse patient population.