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

Objective: To describe the impact of social determinants of health (SDOH) on visual acuity (VA) at presentation among patients with retinal vein occlusion (RVO). Design: A retrospective single-center cohort study. Subjects: 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. Methods: 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). Main Outcome Measures: Factors affecting degree of vision loss at presentation. Results: 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. Conclusions: 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. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.