Racial and Socioeconomic-Based Disparities in Anti-Vascular Endothelial Growth Factor Treatment and Visual Outcomes in Patients with Branch Retinal Vein Occlusions

Abstract

Purpose : Socioeconomic status (SES) and minority racial status are associated with disparities in healthcare quality and disease outcomes.¹ The objective of this project is to assess differences in anti-vascular endothelial growth factor (anti-VEGF) treatment and visual acuity (VA) outcomes of branch retinal vein occlusions (BRVO) across the dimensions of race and SES.

Methods : A retrospective chart review was conducted of all patients with BRVO and cystoid macular edema (CME) treated with anti-VEGF injections at Wake Forest Baptist Health from 2013 to present. Patients were excluded if they had other visually significant visual pathology. Baseline patient characteristics including VA, age, gender, insurance status, phakic status, were recorded. The national percentile of area deprivation index (ADI) was recorded. Anti-VEGF injection type and number of treatments, and final VA outcomes were collected.

Results : 99 eyes of 96 patients were included. 79 patients belonged in the bottom half and 20 belonged in the top half national percentile of ADI. 79 patients identified their race as White and 20 patients identified their race as non-White. The mean presenting logMAR VA of patients in the top 50^th and bottom 50^th percentile ADI was 0.44 and 0.66 respectively (p=0.06); presenting vision was 0.60 for White patients and 0.71 for non-White patients (p=0.24). The mean final logMAR VA of patients in the top 50^th and bottom 50^th percentile ADI was 0.27 and 0.47 respectively (p=0.03); final VA was 0.43 for White patients and 0.50 for non-White patients (p=0.27). The number of anti-VEGF injections per year of follow up for patients in the top 50^th and bottom 50^th percentile ADI was 3.2 and 1.5 respectively, and was 2.5 for White patients and 1.4 for non-White patients. The mean duration of follow up for White patients was 5.2 years and 4.3 years for non-White patients (p=0.16) while it was 4.7 years for the top 50^th percentile and 6.6 years for the bottom 50^th percentile ADI (p=0.03).

Conclusions : Final VA was worse in patients with lower SES, but did not differ between white and non-White patients. The number of anti-VEGF injections was different between White and non-White patients and across measures of ADI. These results may help increase awareness of barriers to ophthalmic care associated with SES and race.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.