Influence of Social Determinants of Health on Presenting Visual Acuity in Retinal Vein Occlusions

TL;DR

This study shows that social factors like deprivation and race affect how bad vision is when people first get diagnosed with retinal vein occlusion.

Contribution

The study identifies specific social determinants of health linked to worse visual acuity at RVO diagnosis.

Findings

Higher social deprivation index scores correlate with worse initial visual acuity in RVO patients.

Hispanic and Black patients are more likely to present with severe vision loss compared to White patients.

Former and never smokers have milder vision loss at RVO diagnosis compared to active smokers.

Abstract

To describe the impact of social determinants of health (SDOH) on visual acuity (VA) at presentation among patients with retinal vein occlusion (RVO).

A retrospective single-center cohort study.

All patients with RVO (central and branch retinal vein occlusion [CRVO and BRVO]) who received their first intravitreal anti-VEGF injection between January 2015 and March 2025 at a single center.

Sociodemographic factors including age, gender, race, and ethnicity were recorded. Social deprivation index (SDI) scores, a proxy for SDOH were determined using zip codes. An aggregate SDOH score was calculated and divided into quintiles, with quintile 5 (Q5) representing the highest SDOH burden. Information on hypertension and smoking status were also collected. Data on best available VA at presentation measurements were collected and were categorized as mild (20/40 or better), moderate (20/50 to 20/100), and severe vision loss (20/200 or worse).

Factors affecting degree of vision loss at presentation.

A total of 9698 patients with RVO were included. Of these, 57% (n = 5490/9698) had a BRVO, and 43% (n = 4208/9698) had a CRVO. The proportion of patients with mild, moderate, and severe vision loss was 25% (n = 2425/9698), 41.8% (n = 4049/9698), and 33.1% (n = 3206/9698), respectively. On multivariable analysis, increasing SDI quintiles (higher SDOH burden) were associated with worse presenting baseline VA in patients with RVO (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.13–1.54; P < 0.001) for patients in the fifth quintile versus those in the first quintile. Odds of severe vision loss at initial RVO presentation were also greater among older patients (OR 1.03, 95% CI: 1.02–1.03; P < 0.001), Hispanics (OR 1.62, 95% CI: 1.22–2.14; P = 0.001) versus non-Hispanics, and Black (OR 1.34, 95% CI: 1.17–1.34; P < 0.001) and Asian (OR 1.30, 95% CI: 1.02–1.67; P = 0.04) patients compared to White patients. Former smokers (OR 1.41, 95% CI: 1.17–1.70; P < 0.001) and never smokers (OR 1.39, 95% CI: 1.17–1.66; P < 0.001) were more likely to have mild vision loss at initial RVO presentation compared to active smokers.

Our study reveals associations between adverse SDOH and presenting VA among patients with RVO. Evaluating and intervening on effects of adverse SDOH may be a means to improve outcomes of patients with RVO.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.