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Ke Zeng, Nicole H. Siegel, Manju L Subramanian, Steven Ness, Xuejing Chen; Effects of Socioeconomic Deprivation on Visual Acuity in Diabetic Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2022;63(7):580 – A0145.
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© ARVO (1962-2015); The Authors (2016-present)
Socioeconomic deprivation is associated with earlier and increased prevalence of diabetic retinopathy. We conducted a retrospective clinical case study to investigate how socioeconomic deprivation affects visual acuity (VA) outcomes in vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR).
This is a retrospective analysis of eyes with PDR presenting with acute VH at a safety-net academic medical center between May 1, 2015 and December 31, 2019. Subject addresses were used to calculate the Massachusetts Area Deprivation Index (ADI), from 1 to 10 with 10 being the most disadvantaged. Two-tailed Welch two-sample t-tests determined differences between low (1-5) and high (6-10) ADI groups. One-way ANOVA was used for measurements involving visual acuity (VA) due to non-normal distributions. The primary outcomes were mean VA, change in VA, and appointment frequency. Subgroup analysis was conducted for different endpoints, including resolution without surgery, progression to surgery, and unresolved cases such as those lost to follow-up. A secondary outcome included time to surgery.
A total of 183 patients were included. The groups of low (n = 86) and high ADI (n = 97) had the same age of presentation (59.2) and similar VA (LogMAR 1.36 v. 1.32). Overall change in VA from presentation to endpoint (resolution without surgery, surgery, or unresolved) was LogMAR -0.53 in the low ADI group versus -0.58 in the high ADI group (△0.05, 95CI -0.20 to 0.30, P=0.68). Low ADI group averaged 5.56 appointments compared to 5.01 in the high ADI group (△0.55, 95CI -0.34 to 1.44, P=0.23). Examining study endpoints, 31.4% achieved resolution without surgery in the low ADI group (vs 21.7% high ADI, P=0.14) and 26.7% in the low ADI group were lost to follow-up or remained unresolved (vs 35.6% high ADI, P=0.23). Among those who progressed to surgery, the low ADI group averaged 7.78 weeks compared to 9.75 weeks in the high ADI group (△-1.98, 95CI -7.36 to 3.40, P=0.47).
There was no statistically significant difference in VA changes and appointment frequency between patients in the low and high ADI groups. The study suggests that there may be a trend for low ADI to be associated with a shorter time to surgery and to achieve resolution without surgery.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
Table 1. Baseline characteristics.
Table 2. Primary visual acuity and secondary outcomes. Lower LogMAR indicates better vision.
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