Sociodemographic disparities in presenting visual acuity of neovascular age related macular degeneration patients

Abstract

Purpose : Studies have demonstrated the importance of presenting visual acuity (VA) on the prognosis of eyes undergoing treatment for neovascular age related macular degeneration (nAMD). However, the impact of how sociodemographic factors influence the distribution of presenting VA in nAMD is less well understood. Therefore, we conducted a study to determine the baseline VA stratified by various sociodemographic characteristics.

Methods : Patients with nAMD that presented to the offices of Mid Atlantic Retina and the Retina Service of Wills Eye Hospital were identified between January 2013 and June 2017. Sociodemographic characteristics included age, race, gender, and regional adjusted gross income (AGI). VA at first injection was recorded and categorized as either minimal (≥20/40), moderate (20/50-20/200), or severe vision loss (<20/200). For patients with bilateral disease, the eye with the worse VA was included in the analysis.

Results : Three thousand two hundred and five patients were eligible for the final analysis. Mean (± standard deviation) baseline logMAR VA was 0.94 (±0.68) (Snellen, 20/174). Six-hundred and seventy-six (21.1%) patients presented with minimal vision loss, 1490 (46.5%) with moderate vision loss, and 1039 (32.4%) with severe vision loss. Prevalence of severe vision loss increased as age increased, with 23% of patients ≤75, 29% of patients between 76-80, 32%, of patients between 81-85, and 42% of patients >85 years presenting with severe loss (p<0.001). There was also a significant increase in the prevalence of severe vision loss as regional AGI decreased, with 41% of incomes ≤$50,000, 34% of incomes between $51,000-$75,000, 29% of incomes between $76,000-$100,000, and 29% of incomes >$100,000 presenting with severe vision loss (p<0.001). There was no significant difference in the prevalence of severe loss between genders (p=0.60). There was no significant difference in vision loss between whites, African-Americans, Asians, and unreported race (p=0.12).

Conclusions : There is a significant disparity in presenting VA between different sociodemographic groups. Given the importance of baseline VA in good vision retention for nAMD, future studies are needed to further identify risk factors associated with poor vison presentation.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.