Abstract
Purpose :
Despite the growing burden of retinal disease in the US, the distribution and practice patterns of retina providers-and the factors that influence these-has not been well studied. We sought to shed light on this important public health issue by performing a retrospective, cross-sectional analysis of publically available national health, census, and income data.
Methods :
Billing codes in a 2016 Medicare dataset were used to identify ophthalmologists who performed anti-vascular endothelial growth factor (anti-VEGF) injections (J2778, J3590, J0178) with or without cataract procedures (66982, 66984, 66821). This dataset was merged with Internal Revenue Service, US Census Bureau, and Centers for Disease Control databases to characterize the mean adjusted gross income (AGI), diabetes burden, and regional attributes where these providers practice. Statistical outcomes were assessed using multivariate logistic regression, chi-square and two-tailed t-tests.
Results :
3113 retina providers—2113 retina specialists and 1000 comprehensive ophthalmologist also performing anti-VEGF injections (“hybrid providers”)—were identified. 96% of zip codes did not have any retina provider (n=29,783). Of the remaining 4%, 52% had just 1 provider and 90% had 5 or fewer (n=1289, max=20 [Houston, TX]). Retina specialists were more likely to practice in locations with higher mean AGI (p<0.001) and in the New England region (OR = 1.42, p<0.001). They were less likely to practice in West North Central region (OR 0.77, p=0.037) or in locations with higher burden of diabetes (p<0.001). In contrast, hybrid providers were more likely to practice in the Mountain (OR=1.74), Pacific (OR=1.70), and West North Central (OR=1.75) regions (p<0.01 for each group), locations with lower mean AGI (p<0.001) and higher burden of diabetes (p=0.007). Retina specialists performed 86% of all anti-VEGF injections (n=5.4 million). The relative frequency of each anti-VEGF agent differed between groups, with hybrid providers more likely to use bevacizumab than retina specialists (18.6% vs. 12.5%, p<0.001).
Conclusions :
Majority of US zip codes do not have a retina provider, and where found, there are differences in distribution and practice patterns between retina specialists and hybrid providers. Understanding these differences is essential when considering interventions to address unequal access to retina care.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.