Utility Assessment of Follow-up Evaluation for Commotio Retinae

Abstract

Purpose: To perform an outcome-and-cost analysis of follow-up visits and associated imaging in patients presenting to the Massachusetts Eye and Ear (MEE) emergency department with commotio retinae. Methods: This retrospective consecutive case series comprised consecutive patients presenting to the emergency department from January 1, 2020, to January 1, 2022, who were diagnosed with contusion or other injuries of the eye or orbit (International Classification of Diseases, 10th edition, codes S05.1 and S05.8). Cost analysis was performed using Medicare fee data and previously described methods. Costs considered included follow-up examinations, optical coherence tomography (OCT), and fundus photography. Results: Of the 490 patients presenting to the emergency department, 201 had findings of commotio retinae on examination and were included in this study. Of the 201 patients with initial commotio retinae, 142 (70.6%) returned for follow-up. OCT was performed in 34% of patients and fundus photography in 33%. A total of 254 follow-up visits were conducted. Four patients (2.8%) had retinal tears on follow-up, with only 1 (0.7%) developing a retinal detachment. Complications requiring intervention were always heralded by worsening symptoms. The total cost of follow-up was $60,436 for the cohort and $425.60 per patient. Conclusions: Patients with commotio retinae infrequently develop retinal complications and have a high rate of loss to follow-up. Significant resources are dedicated to following up and imaging patients with commotio retinae. Our results underscore the low utility in multiple follow-up visits among asymptomatic patients.