Purpose: To evaluate vision loss progression and the association of vision loss with medical care cost, falls, and fractures in patients with geographic atrophy (GA), using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Methods: Patients aged 50 years or older who were diagnosed with GA between April 2016 and December 2021 and had a valid visual acuity (VA) measurement within 90 days before and 1 year after the date of GA diagnosis were evaluated. This post hoc analysis included a homogeneous cohort, a subset of patients for whom the incidence of eye diseases/procedures beyond GA that may affect vision and healthcare resource utilization was controlled. Further evaluation of this cohort described patients with and without subfoveal involvement. Homogeneous claims-linked cohorts were assessed using the IRIS Registry linked to the Komodo Health Research Dataset. Multivariable logistic regression was used to assess the associations of VA with total medical care cost and with incident falls and fractures. Results: A total of 63 616 patients were included. VA was less than 20/100 for 12.8% of patients at diagnosis and 24.3% by year 2. Median time to VA less than 20/40 was 3 years and was faster for those with subfoveal involvement (2.2 years) vs those without (3.8 years). A total of 5827 patients were included in the closed-claims cohorts. By year 2, VA impairment was associated with an increase of more than 26% in total cost of care. Moderate to severe VA impairment was suggestive of an increased risk of falls/fractures. Conclusions: This retrospective study demonstrates an association between vision loss from GA and increased healthcare costs and also suggests a potentially elevated risk of falls and fractures.
Purpose: To compare the Medicaid and Medicare physician reimbursement rates for the top 10 most common vitreoretinal surgeries. Methods: The Medicaid-to-Medicare reimbursement ratios were compared for the most frequently used Common Procedural Terminology (CPT) codes, adjusted for each state's proportion of Medicaid enrollment in the United States. Results: The most used CPT codes were 67042 (26%), 67036 (20%), 67108 (17%), 67041 (11%), 67113 (11%), 67040 (6.5%), 67039 (4.1%), 67121 (2.8%), 67218 (0.44%), and 67107 (0.43%). The weighted average (±SD) of the Medicaid reimbursement rate was 88% ± 2.3% of the Medicare rates. New Jersey had the lowest Medicaid-to-Medicare ratio (52% ± 2.33% of all Medicaid enrollees). Thirty-six states, comprising 80% of all US Medicaid enrollees, had lower Medicaid than Medicare rates; 30 of those states had lesser-of policies, under which physicians would be reimbursed at the lower Medicaid rates despite patients being dually enrolled in both Medicaid and Medicare. Conclusions: There were significant variations between states, but Medicaid reimbursements were on average 12% lower than Medicare rates. In most states, there was a significant opportunity cost for the physician performing the same surgery on a patient with Medicaid compared with Medicare. State governments should work to improve patient access to care, match the Medicaid and Medicare rates, and eliminate lesser-of payment policies.
Purpose: To characterize anatomic and functional outcomes in cases of hemorrhagic posterior vitreous detachment (PVD) and quantify predictors of retinal breaks to provide additional data points for treatment considerations and patient counseling. Methods: This was a retrospective case series of patients with PVD and vitreous hemorrhage (VH) that used electronic health record data dated from 2014 to 2025. Recorded data included demographics, extent of VH, baseline and final best-corrected visual acuity (BCVA), type of management, and number of retinal breaks over the course of follow-up. Logistic regression was used to assess independent predictors of retinal breaks. Results: This study included 79 participants. The median BCVA of patients with fundus-obscuring and nonobscuring VH improved from 20/800 and 20/25 at baseline to 20/30 and 20/20 by the end of follow-up, respectively (P < .001 for both). Thirteen participants experienced a retinal break, 10 of whom had occult breaks. Predictors of retinal breaks included fundus-obscuring VH (odds ratio [OR], 7.9; SE, 0.75; 95% CI, 1.8-34.2; P = .006; Nagelkerke R 2, 0.3) and a BCVA of 20/200 or worse (OR, 7.5; SE, 0.7; 95% CI, 1.9-29.4; P = .004; Nagelkerke R 2, 0.31). Conclusions: Patients with PVD and VH have favorable functional outcomes. In select cases, those with poor vision or fundus-obscuring VH may benefit from early surgical intervention given the heightened risk of occult retinal breaks.
Purpose: To determine whether there is a difference in the risk of ocular hypertension between patients in a large United States healthcare database who received an intravitreal dexamethasone implant and those who received intravitreal (IVT) triamcinolone acetonide injections. Methods: A retrospective cohort study was conducted from 2011 to 2022. Cohorts were created by identifying patients who were treated for the first time with either dexamethasone implants or IVT triamcinolone. The primary outcome was the number of patients requiring treatment for ocular hypertension. Cox proportional hazards regression modeling was performed for risk analyses, and inverse proportional treatment weighting was included. A sensitivity analysis used a new diagnosis of glaucoma or suspected glaucoma as the outcome. Results: In total, 147 (8.8%) of 1665 patients treated with dexamethasone implants and 282 (7.3%) of 3866 patients treated with IVT triamcinolone received medical or surgical therapy for ocular hypertension. In hazards models with inverse proportional treatment weighting of propensity scores, cohorts were found to be balanced in all covariates (standardized mean difference <0.1 for each variable). Cox proportional hazards regression analysis showed no difference in risk of requiring ocular hypertension treatment in the group treated with dexamethasone implants compared with the IVT triamcinolone group in the postinjection period of 1 to 40 days (hazard ratio [HR], 0.77, 95% CI, 0.53-1.12; P = .17). However, analysis after 40 days showed that treatment with dexamethasone implants, as compared with IVT triamcinolone, conferred an increased risk of requiring ocular hypertension treatment (HR, 1.41, 95% CI, 1.08-1.86; P = .01). Sensitivity analyses showed a similar, but nonsignificant risk of progressing to a diagnosis of glaucoma or suspected glaucoma in the dexamethasone implant group compared with the IVT triamcinolone group at 40 days after injection (HR, 1.24, 95% CI, 0.91-1.70; P = .18). Conclusions: Treatment with dexamethasone implants was associated with an increased risk of requiring ocular hypertension treatment when compared with IVT triamcinolone treatment. Clinicians should be aware of this increased risk when counseling patients regarding their treatment options.
Purpose: To determine whether systemically administered immunomodulatory therapeutic agents may be associated with a lower risk of reoperation following initially successful repair of rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective cohort study conducted using the IRIS Registry to identify patients who had undergone surgical repair of RRD and had at least 6 months of postoperative follow-up. Patients receiving systemic immunomodulatory therapy for a non-ocular inflammatory disease at the time of repair (group 1) and control subjects not receiving immunomodulatory therapy at the time of repair (group 2) were identified. The main outcome measure was rate of reoperation within 90 days. Results: Group 1 was composed of 683 patients (705 eyes). Group 2 was composed of 36 298 patients (37 337 eyes). The proportion of eyes requiring reoperation was 78/705 (11.1%) in group 1 and 5119/37 337 (13.7%) in group 2. The risk of reoperation was higher for group 2, with an odds ratio (OR) of 1.30 (95% CI, 1.01-1.66) compared with group 1 (P = .038). Other risk factors associated with additional surgical intervention in groups 1 and 2 were older age (P = .014 and P = .011) and positive smoking history (each P < .001). Conclusions: The need for reoperation following primary RRD repair was lower in patients being treated with systemic immunomodulatory therapy at the time of surgery. Individuals not receiving immunomodulatory therapy were 1.3 times more likely to require reoperation. Additional studies are warranted to assess systemic immunomodulatory therapy as a treatment option for patients at high risk for redetachment due to proliferative vitreoretinopathy.
Purpose: To evaluate functional and structural outcomes after application of a single intravitreal dose of faricimab in patients with chronic retinal diseases. Methods: In this observational, longitudinal, prospective study, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated before and 4, 8, 12, and 16 weeks after a single dose of intravitreal faricimab. Results: A total of 49 eyes of 41 patients were included, of which 28 were treatment-naive eyes (had not previously received intravitreal therapy) and 21 were eyes in which a switch from a previous antiangiogenic agent was indicated. The main diagnoses were diabetic macular edema in 63.3% (31 eyes) and age-related macular degeneration in 24.5% (12 eyes). Ten eyes (20.4%) required additional antiangiogenic injections due to worsening or only partial improvement in CMT, whereas ~58% of eyes completing follow-up did not require further treatment and maintained anatomic improvement on optical coherence tomography throughout the study period. At 4 weeks after initial injection, CMT was reduced a mean 117.5 µm. Statistically significant decreases were maintained over 8, 12, and 16 weeks. In treatment-naive eyes, initial mean reduction in CMT was 119.7 µm, with sustained decreases at all time points, while in the treatment-switch group, initial mean reduction in CMT was 114.6 µm, with sustained decreases at weeks 4 and 8, but not at weeks 12 and 16. In the general sample, 53.1% to 61.0% of eyes demonstrated clinically modest improvements in BCVA, equivalent to 1 to 2 Early Treatment Diabetic Retinopathy Study lines of vision, but visual changes were not statistically significant. Conclusions: Clinically meaningful reductions in CMT were observed and sustained over the 16-week follow-up after a single intravitreal faricimab injection. Notably, a substantial proportion of eyes did not require additional antiangiogenic treatment during follow-up, suggesting that mandatory loading doses may not be universally required to achieve short-term anatomic benefit in selected patients. However, functional gains were modest and did not reach statistical significance, underscoring that anatomic improvement does not necessarily translate into meaningful visual recovery. These findings highlight the importance of individualized dosing strategies in real-world clinical practice and suggest potential implications for reducing treatment burden, costs, and barriers to access in eligible patients.
To evaluate the potential retinal toxicity associated with ritonavir, a protease inhibitor widely used to treat HIV. This study comprised a literature review of PubMed and EMBASE for all published cases of ritonavir-associated retinal toxicity as well as a retrospective chart review of patients treated with ritonavir who underwent bilateral retinal macular and ultra-widefield imaging at an urban tertiary care medical center. Retinal images were evaluated for morphologies consistent with previously reported cases of ritonavir toxicity. The literature review identified 16 cases of retinal toxicity potentially linked to ritonavir, 7 (44%) of which reported liver dysfunction. A chart review of 483 patients taking ritonavir with bilateral retinal imaging demonstrated no cases of ritonavir toxicity, consistent with the literature. Fewer than half of the published cases of ritonavir retinal toxicity had liver dysfunction, suggesting a possible dissociation between the liver and retinal toxicities. Based on the absence of retinal toxicity in our institution's cohort, this study proposes that ritonavir retinal toxicity is far less common than previously considered, there may be a genetic predisposition to ritonavir toxicity, and previous reports may be cases of misdiagnosed hereditary maculopathies.
Purpose: To investigate the incidence, characteristics, and outcomes of ocular toxoplasmosis-associated rhegmatogenous or tractional retinal detachment (RD). Methods: This was a single-center, interventional retrospective case series of consecutive patients diagnosed with ocular toxoplasmosis who subsequently developed rhegmatogenous RD (RRD) or tractional RD (TRD) between January 2013 and October 2022. Patients who were followed for at least 3 postoperative months were included. The location of the retinochoroidal scar, anatomy of the RD, surgical techniques used for repair, and anatomic and visual outcomes were analyzed. Results: Of 422 patients diagnosed with ocular toxoplasmosis, RRD or TRD developed in 36 patients (8.5%). Inclusion criteria were met in 20 eyes of 19 patients. The mean age at RD diagnosis was 47 years, and the mean follow-up was 3.6 years. Most ocular toxoplasmosis-associated RD were rhegmatogenous (75% [n = 15 eyes]), and half of the eyes had active retinochoroiditis at the time of presentation (50% [n = 10]). At final follow-up, median visual acuity (VA) had improved from counting fingers to about 20/80, and single-surgery anatomic success was achieved in 15 of 17 operated eyes (88%), with final reattachment achieved in 100% without silicone oil. Active retinochoroiditis at the time of RD diagnosis was associated with worse final VA after adjustment for confounding variables (P = .005). Conclusions: RRD or TRD occurred in 8.5% of patients with ocular toxoplasmosis. Surgery produces favorable anatomic results, but visual outcomes remain guarded, especially in eyes with active retinochoroiditis.
Purpose: To assess the impact on treatment patterns resulting from underfunding of a large patient copay assistance program (Good Days) in 2024 and 2025. Methods: A 34-item electronic survey was sent to 1860 US members of the American Society of Retina Specialists (ASRS) in April 2025 to assess the effects of Good Days underfunding. Responses were then stratified based on the social deprivation index and poverty levels of the physicians' office locations. Results: A total of 411 responses (22%) were included. Most physicians (94%) reported significant or moderate disruptions in care after Good Days underfunding, and 90% reported patients being unable to receive their preferred drug therapy. Most physicians (93%) switched patients to off-label bevacizumab, with 84% reporting an increase in injection frequency after switching. Approximately 61% of physicians reported that vision loss was observed in patients due to cost-related delays in treatment, and 63% reported patients being lost to follow-up as a result of financial hardship. Most physicians (77%) believed that the underfunded patient copay assistance program disproportionately affected lower income or underserved communities. Physicians working in lower socioeconomic areas were more likely to report that patients requested to delay or miss therapy (50% vs 37%; P = .019), and patients with geographic atrophy were more likely to request treatment interval extensions (56% vs 44%; P = .033). Conclusions: Physicians were concerned about patients losing access to care, increasing treatment frequency with off-label therapies, and possibly losing vision after a large patient copay assistance program was underfunded. Policy makers, insurance companies, and manufacturers should work together to alleviate the financial burden and barriers to care resulting from high patient copays.
To report the clinical and microbiological characteristics of 5 cases of postsurgical endophthalmitis caused by Ralstonia mannitolilytica and to review the relevant literature. Medical records of patients diagnosed with endophthalmitis due to Ralstonia mannitolilytica were retrospectively reviewed. The organism was identified using an automated VITEK system, while antibiotic susceptibility testing was conducted using standard microbiologic protocols. Primary outcome measures included infection control, visual improvement at 4 to 6 weeks of follow-up, and the antibiotic sensitivity profile of Ralstonia. Infection control was achieved in all cases. Visual outcomes were excellent in 3 out of 5 cases. All isolates demonstrated in vitro susceptibility to ciprofloxacin but differential sensitivity to ceftazidime. To our knowledge, this is the first reported case series of culture-proven R. mannitolilytica endophthalmitis. This series highlights the importance of accurate identification and antibiotic susceptibility-tailored management in infections caused by rare organisms such as Ralstonia.
To evaluate long-term outcomes of in-office laser barricade for large (≥2 clock hours) rhegmatogenous retinal detachments (RRDs) and to report the frequency of additional laser treatment or pars plana vitrectomy (PPV). A retrospective chart review was performed of patients treated between 2015 and 2023 at a retina-only private practice in Chicago, Illinois. Included cases were eyes with fundus diagram-confirmed RRDs involving ≥2 clock hours of circumference, and ≥3 months of follow-up. Procedure success was defined as RRD management without requiring PPV. Seventy-six eyes of 72 patients (mean ± SD age, 52.1 ± 17.7 years) were analyzed, with a mean follow-up of 38.6 months. RRD size was a mean ± SD 2.9 ± 1.1 clock hours (range, 2-6). Mean best-corrected visual acuity (BCVA) was 20/31 at baseline and 20/30 at final follow-up. Procedure success rate was 92.1%, with 6 eyes (7.9%) requiring PPV. Thirteen eyes (17.1%) required additional laser barricade. Eyes with phakic lens status, worse baseline BCVA, vitreous hemorrhage, or baseline posterior vitreous detachment were more likely to require PPV, though these associations did not reach statistical significance (P = .06-.08). Laser barricade was performed on same day of diagnosis in 47 eyes (61.8%) and delayed by ≥1 day in 29 eyes (38.2%). Same-day treatment trended toward a higher need for PPV (P = .08 vs delayed treatment). In-office laser barricade is an effective treatment for RRDs spanning ≥2 clock hours, with a 92.1% long-term success rate. Patients not requiring same-day intervention may achieve excellent outcomes with laser barricade alone.
To describe the optical coherence tomography (OCT) features of retinal leukemic infiltrates and determine their association with visual and systemic prognosis in leukemic retinopathy. A retrospective, cross-sectional multicenter study was conducted on patients diagnosed with leukemia from January 2016 to December 2024 who had OCT imaging at presentation. Demographic, clinical, and OCT data were reviewed. Univariate and multivariate regression analyses were performed to identify OCT biomarkers associated with poor visual and systemic outcomes. Seventy-seven eyes of 47 patients (mean age, 41.7 ± 21.75 years; 83% male) were included. Bilateral involvement was present in 70% of patients. Acute lymphocytic leukemia was the most common subtype (53%), followed by chronic myeloid leukemia (25%). Leukemic infiltrates were identified in 39% of eyes, most frequently within the inner retinal layers (70%), with preservation of the retinal pigment epithelium. On univariate regression, cystoid macular edema (CME) (odds ratio [OR], 0.114; 95% CI, 0.014-0.932; P = .043) and ellipsoid zone (EZ) loss (OR, 3.882; 95% CI, 1.289-11.692; P = .016) were significantly associated with visual outcome. Multivariate regression confirmed CME (OR, 0.022; 95% CI, 0.008-0.687; P = .022) and EZ loss (OR, 5.598; 95% CI, 1.571-19.943; P = .008) as independent predictors of poor vision. Infiltrate location, size, and configuration were not associated with visual prognosis. Retinal leukemic infiltrates predominantly involve the inner retinal layers. CME and disruption of the EZ are key OCT biomarkers predictive of poor visual outcome, irrespective of leukemia subtype or infiltrate morphology.
Purpose: To evaluate the association between obstructive sleep apnea and age-related macular degeneration (AMD) and to characterize disease subtype distribution, age trends, and treatment patterns. Methods: A retrospective cross-sectional study was performed between January 1, 2020, and July 30, 2025, of patients aged 50 or older registered in the Epic electronic health record (EHR) system at the University of Miami. AMD prevalence was compared between patients with and without obstructive sleep apnea. Subanalyses included age distribution, AMD subtypes (exudative vs nonexudative), end-stage AMD, and intravitreal injections. Fisher exact test, χ2 test, and Mann-Whitney U test were performed as appropriate. Results: The prevalence of AMD was higher in patients with obstructive sleep apnea compared with controls (1.996% of patients with obstructive sleep apnea vs 1.023% of controls; P < 4.4×10⁻⁷⁰). Patients with AMD who had obstructive sleep apnea were younger (mean ≈ 80.8 vs 84.9 years; P < 1.3×10⁻³⁵). Both exudative (odds ratio [OR], 1.71, P < .001) and nonexudative (OR, 1.47, P < .001) AMD were more common in patients with obstructive sleep apnea. Advanced nonexudative AMD, which was defined as nonexudative AMD with subfoveal involvement, was less frequent in patients with obstructive sleep apnea (7.7% vs 13.8%; OR, 0.52; P < 1×10⁻⁶). Number of intravitreal injections was higher among patients with exudative AMD who had obstructive sleep apnea (60.6% vs 48.0%; OR, 1.83; P < 1×10⁻⁸). Conclusions: Obstructive sleep apnea is associated with nearly double the prevalence of AMD, earlier age of onset, greater risk of both exudative and nonexudative subtypes, and higher intravitreal injection rates. These findings suggest obstructive sleep apnea may contribute to AMD pathogenesis and progression.
Purpose: To report a case of POEMS syndrome presenting with unilateral optic disc edema and unexpectedly low systemic vascular endothelial growth factor (VEGF) levels in the setting of contralateral intravitreal (IVT) anti-VEGF therapy. Methods: A single case was reviewed. Results: A 65-year-old man with branch retinal vein occlusion in the right eye receiving IVT anti-VEGF injections presented with optic disc edema in the left eye. Systemic symptoms included skin hyperpigmentation; shortness of breath; and peripheral neuropathy characterized by numbness, tingling, swelling, and weakness of his extremities. Imaging demonstrated pachymeningeal enhancement, mixed sclerotic and lytic bone lesions, lymphadenopathy, and splenomegaly. Laboratory evaluation workup revealed a monoclonal gammopathy, and lymph node biopsy findings were consistent with the plasma cell variant of Castleman disease, supporting a diagnosis of POEMS syndrome. Notably, systemic VEGF levels were unexpectedly low (8.7 pg/mL, normal <96.2 pg/mL), likely secondary to the IVT anti-VEGF injection. Conclusions: This case highlights an atypical presentation of POEMS syndrome with unilateral disc edema and suppressed systemic VEGF levels, potentially confounded by contralateral IVT anti-VEGF treatment. Awareness of this interaction is important for accurate interpretation of VEGF levels and timely diagnosis.
Purpose: To determine whether large language models (LLMs) can be harnessed to improve the readability of educational material for retina patients. Methods: Forty-one documents (fact sheets presented in portable document format), each representing a vitreoretinal condition, from the American Society of Retina Specialists (ASRS) Retina Health Fact Sheets website, were downloaded in November of 2024. The multimodal LLM Generative Pre-trained Transformer 4 (GPT-4) was accessed through ChatGPT to generate patient education material on the same 41 vitreoretinal conditions. The model was then prompted to adjust the texts to a sixth-grade reading level. The text outputs for each of the 41 conditions were then analyzed through a readability calculator, and the Average Reading Level Consensus Calc (ARLCalc) score, a normalized average of 8 validated readability formulas that reflect a consensus readability grade level of the text, was recorded. Results: The ARLCalc scores for the ASRS Fact Sheet, GPT-4 Response, GPT-4 Enhanced, and ASRS Enhanced responses were 12.85 (± 0.89), 12.37 (± 0.97), 8.66 (± 0.87), and 9.37 (± 1.09), respectively. A statistically significant difference was found between the 4 groups (P < .001). Conclusions: LLMs may be used as a tool to improve the readability of patient-facing text. Patient education material created by specialty-trained authorship committees remains the gold standard for providing accurate medical information.
Purpose: To identify variables associated with successful surgical outcomes in eyes receiving a scleral-sutured intraocular lens (IOL).Methods: Eyes of patients ages ≥18 years at time of IOL insertion and with ≥1 follow-up visit were included. Eyes with concurrent ophthalmic procedures other than pars plana vitrectomy or with follow-up at outside institutions were excluded. Demographic, biometric, preoperative, intraoperative, and 3-month postoperative variables were collected from electronic medical records. Success following scleral-sutured IOL placement was defined primarily as vision improvement (visual acuity 20/40 or better or ≥3 Snellen lines of improvement) and secondarily as refractive improvement (within 0.5 diopters of refractive target) at 3 months postoperatively. Comparisons of success vs failure groups included t tests, Wilcoxon signed-rank tests, χ2 tests, and Fisher exact tests. Using a random forest model, associated variables were identified and incorporated into multivariable logistic regression to determine the likelihood of vision and refractive success, expressed as odds ratios (ORs) with 95% CIs. P values less than or equal to .05 were considered significant.Results: A total of 182 eyes received a scleral-sutured IOL. At 3 months postoperatively, the median number of complications was 0, and the improvement in logMAR visual acuity was 37%. In total, 72% of eyes met vision success criteria. Worse preoperative vision was associated with higher odds of 3-month postoperative vision success (OR, 3.92, 95% CI, 2.03-8.66; P < .001), whereas having more preexisting ocular conditions compared with fewer preexisting ocular conditions (OR, 0.55, 95% CI, 0.37-0.78; P = .001) and use of CZ70BD lenses compared with use of Akreos AO60 lenses (OR, 0.23, 95% CI, 0.07-0.72; P = .01) were associated with lower odds of vision success. In total, 24% of eyes met refractive success criteria. Lower power IOLs were associated with refractive success (mean IOL power, 16.4 diopters vs 18.0 diopters in success vs failure groups; P = .05), showing a positive correlation (R = 0.3, P = .002).Conclusions: This study suggests that preoperative ocular status and intraoperative considerations, like lens brand, may affect patient outcomes. Ultimately, this may guide surgical planning and postoperative expectations for visual and refractive potential after scleral-sutured IOL implantation.
To present a case series of patients who underwent pars plana vitrectomy (PPV) for dense vitreous hemorrhage (VH) secondary to avulsed retinal vessels in the setting of acute posterior vitreous detachment (PVD). The clinical presentation, surgical management, and outcomes of patients who underwent PPV for VH caused by avulsed retinal vessels were evaluated. Four patients underwent PPV for dense VH. After evacuation of the VHs, all eyes were found to have avulsed retinal vessels without retinal tears. Dense VH in the setting of a PVD may preclude adequate examination of the fundus and require urgent PPV for timely management of possible retinal tears, retinal detachments, or avulsed retinal vessels. Retinal vessel avulsion without retinal tear is an uncommon but important cause of dense VH and may have favorable outcomes after vitrectomy.
Purpose: To describe the management and outcomes of maculopathy in 3 eyes from 2 patients with papillorenal syndrome, a rare disorder associated with variable ocular manifestations, including cavitary optic nerve anomalies and maculopathy. Methods: A retrospective review of 3 eyes from 2 patients with papillorenal syndrome was performed. Results: Of the 3 eyes affected with maculopathy, 2 underwent pars plana vitrectomy with endolaser and intraocular tamponade, while 1 eye was treated with laser photocoagulation alone. In Case 1, the surgically treated eye achieved complete resolution of the maculopathy 15 months after the second surgery. The fellow eye, treated early with laser photocoagulation alone, demonstrated complete resolution of intraretinal fluid at 2 years. In Case 2, the maculopathy was treated surgically, with resolution of subfoveal fluid by 10 months postoperatively. Conclusions: Our cases highlight the importance of early recognition and timely intervention in papillorenal syndrome-associated maculopathy to prevent vision loss. However, the optimal timing and approach to treatment remain uncertain. Further studies are needed to standardize nomenclature and refine management strategies for this rare condition.
Purpose: To evaluate vitreoretinal surgeons' access to operating rooms and potential barriers to care. Methods: An electronic survey of the American Society of Retina Specialists was performed in 2025. Results: Of the 276 respondents, most (90% [248]) were concerned about obtaining sufficient operating room time, with more than half (54% [150]) reporting increased difficulty accessing hospital operating rooms even during the weekdays and 45% (124) reporting increased difficulty accessing hospital operating rooms at nights and weekends. The most common reasons for limited access to operating rooms included block time/scheduling conflicts (61% [169]), anesthesia limitations (59% [162]), staffing limitations (51% [142]), and lower relative reimbursements for vitreoretinal surgeries (45% [125]). Most surgeons (94% [259]) believed that restricting operating room access adversely impacted patient care, leading to delays for urgent retinal detachment repairs (77% [212]), increased travel burden for patients (62% [170]), and worse patient outcomes (41% [113]). Patients treated in lower socioeconomic areas had to travel farther for surgery (median of 19 vs 9 miles for ambulatory surgery centers, P < .001, and 17 vs 9 miles for hospitals, P < .001). Practices have compensated by relying more on in-office procedures (46% [128]) and referrals to academic centers (39% [108]). Conclusions: Vitreoretinal surgeons were concerned about access restrictions to operating rooms and the potential impact on patients. Potential reasons for limited operating room access were likely multifactorial but included limited block time, restrictions in anesthesia and staff availability, and lower relative surgical reimbursements.
Purpose: To compare the costs and reimbursement rates of retinal detachment (RD) repair surgeries in pediatric vs adult patients. Methods: Current Procedural Terminology (CPT) codes for scleral buckle (67107), standard RD repair (67108), and complex RD repair (67113) from January 2017 to May 2024 were extracted. A total of 103 pediatric cases and 549 adult cases were included. A cost analysis was performed using the time-driven activity-based costing methodology. Results: For scleral buckles, total costs were not significantly different between the pediatric and adult groups ($8,884.23 vs $7,878.26, respectively; P = .14). For standard RD repair, there was a significant difference in total material costs ($1,366.71 vs $1,023.66; P = .0013), grand total costs ($8,163.56 vs $5,076.18; P < .001), and day-of-surgery time costs ($6,796.87 vs $4,087.74; P < .001) for pediatric vs adult cases, respectively. For complex RD repair, grand total costs ($10,261.2 vs $9,528; P = .14) were equivalent. Net margins of RD repair under Medicare were -$3,296.52 and -$2,323.55 for scleral buckle, -$2,568.45 and +$430.93 for standard pars plana vitrectomy (PPV) repair, and -$4,467.92 and -$3,745.72 for complex PPV repair, for pediatric and adult patients, respectively. Conclusions: Pediatric standard vitrectomy had 60.8% higher total costs compared with that of adults. There was a net margin loss for standard PPV in pediatric patients (-$2,568.45), with only 68.5% of costs covered under Medicare. Net margin losses were also observed for complex RD repairs in both pediatric (-$4,467.92) and adult surgeries (-$3,745.72), with 56.4% and 60.7% of the costs covered under Medicare, respectively. Pediatric standard vitrectomy, scleral buckle, and complex PPV had greater losses compared with adult surgeries.