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Original Investigation
February 16, 2017

Incidence of and Risk Factors for Developing Idiopathic Macular Hole Among a Diverse Group of Patients Throughout the United States

Author Affiliations
  • 1Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
  • 2Mid Atlantic Retina, Plymouth Meeting, Pennsylvania
  • 3Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor
  • 4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 5School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor
  • 6Department of Epidemiology and Biostatistics, University of California–San Francisco
  • 7Department of Ophthalmology, University of California–San Francisco
JAMA Ophthalmol. Published online February 16, 2017. doi:10.1001/jamaophthalmol.2016.5870
Key Points

Question  What are the incidence of and risk factors for developing idiopathic macular hole in a diverse US-based patient population?

Findings  In a longitudinal cohort of beneficiaries enrolled in a large managed care network from 2009 to 2012, female sex and age were found to be the strongest risk factors for developing idiopathic macular hole.

Meaning  These data confirm across a large managed care network that female sex is strongly associated with development of idiopathic macular hole, with the effect varying across ages differently for females vs males; these differences may contribute to the underlying pathophysiologic factors of the development of macular hole.

Abstract

Importance  Idiopathic macular holes (MHs) are a cause of decreased vision among older Americans. A better understanding of risk factors for MH may help clarify the pathophysiologic factors of MH and identify potential new avenues for preventing and treating idiopathic MHs.

Objective  To determine the incidence of and risk factors associated with the development of idiopathic MH requiring surgical repair with vitrectomy among a large group of managed care plan beneficiaries throughout the United States.

Design, Setting, and Participants  A retrospective, longitudinal cohort study was conducted of all beneficiaries 40 years or older who were continuously enrolled for 3 or more years in a nationwide US managed care network between January 1, 2001, and December 31, 2012, who had 2 or more visits to an eye care professional. The managed care network was queried starting in 2009, and data analysis was conducted from December 1, 2014, to August 15, 2016.

Main Outcomes and Measures  Development of idiopathic MH requiring surgical repair with vitrectomy.

Results  Of the 659 347 enrollees who met inclusion criteria (391 674 females and 267 683 males; mean [SD] age, 56.2 [9.2] years), 144 (0.02%) developed an MH requiring vitrectomy. After adjusting for confounding factors, females had a 64% increased risk of developing MH compared with males (adjusted hazard ratio, 1.64; 95% CI, 1.11-2.43; P = .01), with the effect of sex varying across ages. Compared with white participants, Asian-American enrollees had a 177% increased risk of developing an MH (adjusted hazard ratio, 2.77; 95% CI, 1.27-6.02; P = .01).

Conclusions and Relevance  In this large cohort, sex was confirmed to be associated with developing an MH requiring vitrectomy; the effect varies across ages differently for females vs males. These differences may be the basis for the underlying pathophysiologic factors of the development of MH.

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