Abstract
Purpose :
Rates of diabetic retinopathy (DR) and diabetic macular edema (DME) are increasing
worldwide, with Black and Hispanic patients displaying worse baseline VA at clinical presentation than White patients (Maholtra, 2021). This study used real-world data to quantify disparities in visual acuity (VA) outcomes at one and two years after initiation of DR/DME treatment in patients based on race/ethnicity (Black, Hispanic, and White) as well as on insurance status (Medicare, Medicaid, or Private).
Methods :
We examined the IRIS registry, which includes de-identified data on over 70 million unique patients, including subjects that met strict criteria for presence of a full data-set of information (VA over two years, insurance status, race, treatment provided) and excluding subjects with other comorbidities that might necessitate treatment with anti-VEGF agents. The modified DRSS severity scale was used to classify DR and DME.
Results :
With 43,273 eyes, mean VA at baseline were 67.3, 66.3, and 65.2 in White, Black, and Hispanic patients, respectively. After one year, White patients saw a 1.7 letter improvement, relative to a 1.3 and 1.1 letter improvement in Black and Hispanic patients, respectively. Differences persisted after controlling for insurance. A significantly lower proportion of White patients demonstrated 15-letter loss in VA after 1 year than both Hispanic and Black patients and a significantly lower proportion of 15-letter loss in VA after 2 years than Black patients.
Mean modified-DRSS scores at baseline were 56.0, 57.3, 60.7 in White, Black and Hispanic patients. Hispanic patients had a higher proportion of treatment with bevacizumab than White and Black patients across all disease severities, while White patients had a higher proportion of treatment with aflibercept than Black and Hispanic patients across most disease severities.
Conclusions :
Race and insurance-based differences in one and two year outcomes following anti-VEGF treatment for DR and differential administration of anti-VEGF therapies by both race and insurance necessitate ongoing examination to ensure earlier and more effective treatment of DR patients nationally.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.