title: Incidence of and Risk Factors for Developing Idiopathic Macular Hole Among a Diverse Group of Patients Throughout the United States.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Development of idiopathic MH requiring surgical repair with vitrectomy.
  
  
  
  Of the 659 357 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 MH (adjusted hazard ratio, 2.77; 95% CI, 1.27-6.02; P = .01).
  
  
  
  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 contributing to the development of MH.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco.
authors.forename: Ferhina S
authors.initials: FS
authors.lastname: Ali
authors.affiliation: Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor4School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
authors.affiliation: Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Blachley
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ackley
authors.affiliation: Department of Ophthalmology, University of California, San Francisco.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D012167:Retinal Perforations / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014821:Vitrectomy