Impact of Social Vulnerability Index and Distance to Tertiary Ocular Emergency Department in Patients Presenting with Open Globe Injury

Abstract

Purpose

To evaluate the impact of Social Vulnerability Index (SVI) and the distance to a tertiary eye emergency department (ED) on presenting visual acuity (VA), final VA, and rates of VA change over time in patients presenting with open globe injury (OGI).

Design

Retrospective cohort study.

Participants

Patients with OGI from 2018 to 2021 were identified from the electronic health records using the International Classification of Diseases coding system.

Methods

Data collected included demographics, insurance status, follow-up visits, and VA measurements. Social Vulnerability Index scores were calculated using a US Census Geocoder and stratified into quartiles, and distances to the eye ED were calculated. Simple logistic regression models evaluated the associations of presenting and final VAs with SVI, distance, baseline characteristics, and time from injury to presentation, adjusting for potential confounders. Univariable and multivariable linear regression models analyzed the associations between VA rates of change over time and SVI, distance to ED, demographics, insurance, and presenting VA.

Main Outcome Measures

The relationship between SVI and distance on presenting VA, final VA, and rates of longitudinal VA change over time.

Results

A total of 446 patients presented with an OGI. Of these patients, 337 (75.0%) with complete SVI data were included in the final analysis. Social Vulnerability Index was associated with nearly a fourfold increased risk of worse presenting VA in populations with higher vulnerability compared with those with lower overall vulnerability (odds ratio [OR] = 3.85; 95% confidence interval [CI]: 1.34–11.05; P = 0.012). Greater distance from the eye ED was also a contributing factor to higher risk of poorer presenting VA (OR = 2.55; 95% CI: 1.42–4.60; P = 0.002). On multivariable analyses, longitudinal VA change over time was not impacted by SVI (P > 0.05 for all groups), and final visual outcome was not associated with either SVI or distance to the eye ED.

Conclusions

Greater distances from the eye ED and social vulnerability were associated with a higher risk of worse VA at presentation. However, no significant impact of SVI or distance was observed on long-term VA changes and final visual outcome on the multivariable analyses.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.