Objective To investigate the effect of the COVID-19 pandemic on the clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, consecutive case series with historical controls. Subjects Consecutive patients presenting with primary RRD in a 50-day period during the USA COVID-19 pandemic (March 9 th - April 27 th , 2020) and the corresponding 50-day period in the previous year (March 4 th - April 22 th , 2019). Methods The cohorts were compared to assess demographic variables and clinical presentations. Multivariate logistic regression was used to identify factors predictive of presenting macular attachment status. Main Outcome Measure The primary outcome was the proportion of patients with macula-on RRD at presentation. Secondary outcomes included visual acuity (VA), duration of symptoms prior to presentation, proportion presenting within one day of symptom onset, and presence of primary proliferative vitreoretinopathy (PVR). Results Eighty-two patients were included in the 2020 cohort compared to 111 patients in the 2019 primary control cohort. Demographic factors were similar between the groups. Significantly fewer patients presented with macula-on RRD in the 2020 cohort (20/82 patients, 24.4%) than in 2019 (55/111 patients, 49.5%, p = 0.001). Patients in the 2020 cohort had worse median VA at presentation (LogMAR 1.00, Snellen 20/200 in 2020 versus LogMAR 0.48, Snellen 20/60 in 2019, p = 0.008), fewer patients presenting within one day of symptoms (16/80 patients [19.5%] in 2020 versus 41/106 patients [36.9%] in 2019, p = 0.005), and a greater proportion with primary PVR (11/82 patients [13.4%] in 2020 versus 5/111 patients [4.5%] in 2019, p = 0.03). In multivariate analysis, younger age (p = 0.03) and established patient status (p = 0.02) were independent predictors of macula-on status in the 2020 cohort. Conclusions Patients with primary RRD during the 2020 COVID-19 pandemic were less likely to be macula-on and more likely to have delayed presentation, worse vision, and PVR.

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