Clinical research from the Nuffield Department of Population Health, University of Oxford, has shown a considerable increase in the annual number of retinal detachments recorded in England over the past four decades. The Oxford-based study demonstrated that the annual rate of retinal detachment (RD) increased from 13.4 in 1999 (13.1 to 13.8) to 15.4 in 2011 (15.1 to 15.7), primarily due to an increase in the number of people with diabetes. The research additionally reported that the rate of RD across different geographies showed little or no correlation with social deprivation (r2=0.01) or with ethnicity [Black (r=0.04), Asian (r =-0.03)].
The research report, published in the British Journal of Ophthalmology (doi:10.1136/bjophthalmol-2014-305774) used data collected from both the English national hospital statistics, held by the Office of Population Censuses and Surveys, and from the Oxford Record Linkage Study (ORLS) which includes statistical summaries for all day cases and inpatients treated in the former Oxford National Health Service (NHS) regional health authority area. According to analysis of the collected data, the national rates for RD in England, or the annual “episode-based admission rate” (a count of admissions rather than people), illustrated an increase from 10.4 per 100,000 population in 1968 (95% CI 9.5 to 11.3) to 13.6 in 1990 (13.3 to 13.9) and 17.6 in 1998 (17.3 to 18.0). When episode based rates and person-based rates were compared it appeared that episode-based rates showed a steeper rise, indicating an increase over time in multiple admissions per person. From 1999 onwards a clear change in the rate of increase could be observed, increasing more steeply from 17.0 (16.6 to 17.3) to 24.0 in 2011 (23.6 to 24.4). Reviewing the data across the entire period of 43 years the researchers observed that there was no evidence of a systematic increase through the 1960s, 1970s or 1980s but from about 1990 onward the rate of RD doubled over the following 20 years.
The highest rates of RD were in the age group of 65–74 years and, from the age of 45 years or more, men generally had higher rates of RD than women. The increasing incidence with age was starkly evident from the finding that 8.6 people per 100,000 in the 15–44 year bracket reported a RD while the figure climbed to 51.1 in the 65–74 year old group in men between 2007 and 2011. The authors of the study conclude that, “from the 1960s when rates were probably stable, admission rates for RD seem to have increased in recent years. The increase is probably attributable to an increase in the prevalence of diabetes, and so an increase in RD associated with diabetes”. As urgent referral to a specialized ophthalmologist is required to avoid permanent damage from retinal detachment, it is critical to collect accurate information on trends and variation in respect of time and locations. Such information can then be employed to efficiently map resources to needs, especially in a publically funded healthcare system such as the NHS.