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David Cui, Priya Mathews, Gavin Li, Lee Guo, Shanna Van Court, Esen Akpek; Disparities in Dry Eye Severity and Access to Dry Eye Care in Racial and Ethnic Minorities. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1251.
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© ARVO (1962-2015); The Authors (2016-present)
To assess dry eye severity and access to dry eye care in racial and ethnic minorities.
Patients with dry eye seen at a tertiary academic medical center, evaluated between 2003 to 2020 were identified using international classification of disease codes M35.0, H16.222, H04.123, 710.2, 375.15. According to self-identified demographics for race and ethnicity, four cohorts of patients were created: Asian, Black, Hispanic, and White. Retrospective review of electronic health records was performed to collect demographics, socioeconomic factors, prior access to dry eye care, and clinical dry eye parameters at baseline as well as last visit.
A total of 464 patients were included (156 White, 85 Asian, 157 Black, and 66 Hispanic). Compared to White patients (3.2%), a greater proportion of minorities lacked health insurance or were on Medicaid (Asians 10.6%, p=.019; Blacks 8.3%, p=.054, Hispanics 18.2%, p<.001). Blacks and Hispanics had a lower estimated median household income than Whites (Whites $98,260; Blacks $75,554, p<.001; Hispanics $86,839, p=.0331). At baseline visit, lower proportion of minorities had received prescription treatment or in office dry eye procedure (Whites 61.5%; Asians 43.5%, p=.007; Blacks 30.57%, p<.001; Hispanics 43.9%, p=.016). There was no difference with regard to autoimmune disease prevalence at final visit, or diagnosis during follow-up (P > .05). In addition, at baseline visit, minorities (compared to Whites) had worse clinical dry eye parameters for mean conjunctival lissamine green staining score (Whites 1.69; Asians 2.44, p=.032; Hispanics 2.60, p=.012), corneal fluorescein staining score (Whites 1.56; Asians 2.25, p=.005; Blacks 2.47, p<.001; Hispanics 2.42, p=.001), and tear osmolarity (Whites 299.54 vs Blacks 307.98, p=.001). Following appropriate treatment, patients with a minimum of 18 months of follow up had no statistically significant differences for any clinical dry eye measurements at final visit.
Our findings demonstrate that racial and ethnic minorities present with worse dry eye parameters. This might be due to disproportionate access to dry eye care, potentially secondary to socioeconomic barriers as well as underappreciation of dry eye among minorities leading to differential treatment by providers.
This is a 2021 ARVO Annual Meeting abstract.
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