Association of neighborhood indices on outcomes of patients with proliferative sickle retinopathy.

PURPOSE: To evaluate the association between neighborhood-level disadvantage, measured by the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), and disease severity at presentation, treatment modality, and clinical outcomes in a cohort of Black patients with proliferative sickle cell retinopathy (PSR).

METHODS

This retrospective cohort study included Black patients with PSR (Goldberg stages 3-5) seen at a metropolitan academic ophthalmology center from May 1, 2014, to December 31, 2022. Patient demographics, treatment patterns, and clinical outcomes were extracted from electronic medical records. Patient addresses were linked to SVI/ADI at the census tract level. Multiple linear regression analyses were conducted to assess associations between SVI/ADI and disease stage, treatment type (intravitreal injection [IVI], panretinal photocoagulation [PRP], pars plana vitrectomy [PPV]), and outcomes, including change in best-corrected visual acuity and post-treatment complications.

RESULTS

The study included 110 eyes from Black patients with PSR. Neither SVI nor ADI was significantly associated with disease stage at presentation, initial treatment modality, or clinical outcomes (p > 0.05 for all models). PPV was the most common initial treatment (42 %), followed by PRP (36 %) and IVI (10 %). Patients undergoing PPV and IVI required significantly more follow-up visits (p = 0.032).

CONCLUSION

Neighborhood disadvantage, as measured by SVI/ADI, was not significantly associated with disease severity, treatment selection, or clinical outcomes in this cohort of Black patients with PSR. Patients undergoing PPV or IVI required significantly more follow-up visits (p = 0.032), highlighting the substantial management burden for these patients. While neighborhood disadvantage was not significantly associated with outcomes, larger studies are needed to further assess these relationships. Regardless of measured neighborhood disadvantage, the substantial follow-up burden associated with PSR management underscores the importance of addressing individual-level barriers and support systems in this high-risk population.