Abstract
Purpose :
To determine whether underserved demographic factors are associated with the treatment differences for Fuch’s dystrophy. We hypothesized that the rate of penetrating keratoplasty (PK) and endothelial keratoplasty (EK) are associated with race and socio-economic factors.
Methods :
Patients 40 or older with a Fuchs dystrophy diagnosis and a subsequent corneal edema diagnosis were identified from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) based on ICD 9 and 10 codes. We calculated incidence rates (/1000 person-years) for various demographic factors for PK, and EK or PK outcomes. Multivariable Cox proportional hazard models were fit to examine the relationships between demographic factors and time from date of the Fuchs dystrophy diagnosis to time of PK and EK/PK. Patients with unknown birth sex, coverage type, race or ethnicity were excluded.
Results :
A total of 15,137 patients with a Fuchs dystrophy diagnosis and a subsequent corneal edema diagnosis were identified. Of those, 296 patients underwent PK, 3,073 underwent EK, and 3,289 underwent EK or PK. Incidence rates of PK and EK are shown in Table 1.
Asian American patients were 2.78 times more likely (1.33-2.68, <0.01) and Black or African American patients were 1.89 times more likely (CI 1.54-4.99, p <0.01) to undergo PK compared to White patients. Hispanic/Latinx patients were 1.86 times more likely (1.12-3.09, 0.02) to undergo PK compared to non-Hispanic/Latinx patients. (Fig.1)
Asian American patients were 0.72 times as likely (0.54-0.96, 0.03) to undergo EK or PK compared to White patients. Patients with commercial insurance were 1.54 times more likely (1.39-1.69, <0.01), and patients with Medicare Advantage were 1.22 times more likely (1.09-1.37, <0.01) to undergo EK or PK compared to patients with Medicare insurance. (Fig.2)
Conclusions :
Patients of underserved demographic factors including race, ethnicity, and insurance type were more likely to undergo PK as compared to EK. These same patients were less likely to undergo either surgical treatment when compared with other demographic groups.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.