Modern approaches to risk stratification and prevention of primary rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment (RRD) remains one of the most severe pathologies in ophthalmology, leading to irreversible vision loss. Existing clinical guidelines focus on a limited set of risk factors, while modern data indicate a significantly broader range of predictors. Based on a comprehensive analytical review of publications in the international and Russian bibliographic databases PubMed, Google Scholar, eLibrary, Scopus, Web of Science, Cochrane Library, CyberLeninka over the past 10 years, known risk factors for RRD have been systematized, a critical analysis of gaps in the current prevention system has been carried out, and the need to develop a risk stratification system for the transition to proactive and personalized care has been substantiated. To develop a stratification system, a methodology is proposed that includes a systematic review to identify risk factors and the subsequent application of analytic hierarchy process to assess their combined impact and interrelationships. As a result, a wide range of risk factors for RRD has been identified, including demographic, ocular, genetic, behavioral, and socio-economic determinants. Three key gaps in the prevention system have been identified: the lack of assessment of the combined impact of factors, active screening, and systematic work with identified risks. It has been shown that existing protocols do not allow for a quantitative assessment of individual combined risk and are not focused on proactively identifying patients from high-risk groups. The proposed step-by-step research approach is aimed at overcoming these limitations. Thus, the development and implementation of a patient routing system based on a “traffic light”-type approach, using a comprehensive risk assessment, will take the prevention of RRD to a qualitatively new level, reducing the medical, social, and economic burden of the disease.