Risk Factors and Individualized Risk Stratification for Sequential Bilateral Rhegmatogenous Retinal Detachment

PURPOSE: To identify predictors of sequential bilateral rhegmatogenous retinal detachment (RD) and quantify patient-level risk of fellow-eye involvement following unilateral RD. METHODS: Adults undergoing RD repair at a tertiary center from 2010 to 2023 were included. Demographic and clinical characteristics were compared between unilateral and bilateral cases, and multivariable logistic regression was used to identify predictors of fellow-eye detachment. Predicted probabilities of sequential bilateral RD were generated across combinations of axial length, age, and sex. RESULTS: Among 1,480 patients, 185 (12.5%) developed RD in the fellow eye. Patients with sequential RD were younger, more often male, and had longer axial length. Axial length was the strongest predictor of bilateral RD, with each millimeter increase associated with a 17% increase in odds (OR 1.17, 95% CI 1.07-1.27). Younger age and male sex showed smaller independent associations. Although fellow-eye detachments presented earlier and with slightly better visual acuity, more than one third were still macula-off at presentation. CONCLUSIONS: Approximately one in eight patients with rhegmatogenous RD develops detachment in the fellow eye. Risk is strongly influenced by axial length and is concentrated in younger, highly myopic patients. These findings support risk-stratified surveillance after unilateral RD using simple clinical measurements available at routine examination.