Purpose

To evaluate whether greater socioeconomic disadvantage, as measured by state Area Deprivation Index (ADI), is associated with patients who underwent enucleation or evisceration.

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Methods

A retrospective review was conducted of 110 eyes that underwent enucleation or evisceration between 2015 and 2021 at a tertiary academic center. Data collected included age, sex, ethnicity, insurance, address, indication, and surgical procedure. Socioeconomic status was assessed using the state Area Deprivation Index (ADI) [Kind AJH, Buckingham W. NEJM, 2018; University of Wisconsin School of Medicine and Public Health] and stratified into low ADI (1–5) and high ADI (6–10) groups; six incarcerated patients without ADI data were classified as high ADI. Higher ADI scores reflect higher levels of adverse social exposome. Group differences in indications were analyzed using the Fisher–Freeman–Halton exact test, and surgical procedure differences were assessed using Fisher’s exact test.

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Results

Of 110 cases, 12 (10.9%) were classified as low ADI and 98 (89.1%) as high ADI. Indication patterns differed significantly between groups (p = 0.0062). In the low ADI group, perforation/ulcer was the most common indication (66.7%), with no cases of cancer, trauma, or endophthalmitis. Phthisis bulbi was also more frequent in the low ADI group (25.0% vs 5.1%). In contrast, the high ADI group demonstrated a broader distribution of indications, including trauma (25.5%), perforation/ulcer (28.6%), glaucoma (18.4%), cancer (11.2%), and endophthalmitis (11.2%). Surgical procedure also differed significantly by ADI group, with enucleation occurring exclusively in the high ADI cohort (p = 0.0187).

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Conclusion

Area deprivation index was significantly associated with both surgical indications and procedure type. Patients from greater adverse social exposome more frequently presented with acute and severe ocular pathology and were more likely to have enucleation. These findings highlight a disproportionate burden of severe ocular disease and surgical eye removal among social and environmentally disadvantaged populations.

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Additional Authors

First name	Last name	Base Hospital / Institution
Tyler	Lin	University of California Davis Health
Pelin	Celiker	University of California Davis Health
William	Lee	University of California Davis Health
Joyce	Kang	University of California Davis Health
Malia	Tieu	University of California Davis Health
Esther	Kim	University of California Davis Health

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