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PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair
  1. Louis Z Cai1,
  2. Jeffrey Lin2,
  3. Matthew R Starr3,
  4. Anthony Obeid1,
  5. Edwin H Ryan4,
  6. Claire Ryan4,
  7. Nora J Forbes1,
  8. Diego Arias1,
  9. Michael J Ammar1,
  10. Luv G Patel1,
  11. Antonio Capone5,
  12. Geoffrey Guy Emerson6,
  13. Daniel P Joseph7,
  14. Dean Eliott8,
  15. Omesh P Gupta1,
  16. Carl D Regillo1,
  17. Jason Hsu1,
  18. Yoshihiro Yonekawa1
  19. For the Primary Retinal Detachment Outcomes (PRO) Study Group
  1. 1Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2Biostatistics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  3. 3Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
  5. 5Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
  6. 6Retina Center of Minnesota, Minneapolis, Minnesota, USA
  7. 7The Retina Institute, St. Louis, Missouri, USA
  8. 8Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Yoshihiro Yonekawa, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; yyonekawa{at}


Background/aims To compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system.

Methods Analysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200).

Results A total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher.

Conclusions Independent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.

  • retina
  • treatment surgery
  • vision

Data availability statement

No data are available.

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Data availability statement

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  • Presented at Macula Society 2021 (Virtual).

  • Contributors LC, JL, MS and YY were primarily responsible for data analysis as well as drafting the original manuscript. AO, EHR, CR, NJF, AC, GGE, DPJ, DE, OG, CR, JH, DA, MJA, LP and YY were primarily responsible for planning, conception and original design of the study. All authors revised the manuscript for important intellectual content and gave final approval for the version published. YY is the author responsible for the overall content as the guarantor.

  • Funding This study was funded by Phillips Eye Institute Foundation, Vitreo and Retinal Surgery Foundation.

  • Competing interests Consultant for Alcon (CR, DE, OG, YY), Grant support from Alcon (AC), Royalties from Alcon (EHR), Stockholder in Aldeyra Therapeutics (DE, CR), Consultant for Dutch Ophthalmic (DE), Scientific Advisory Board for Pykus Therapeutics (DE), Stockholder in Valiant and Glaukos (GGE).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.