Abstract
Purpose :
Dementia is a common comorbidity among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). Disparities in ophthalmic care for those living with dementia have not been examined. This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia.
Methods :
Optum’s de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from all newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of patients newly diagnosed with dementia, which was defined as the index date. Dementia patients were then matched up to 3:1 based on disease, age, race, sex, and insurance plan start and stop date (±4 months). The primary outcome was the number of visits to an eye care provider in the year following the index date. Secondary analyses for the POAG cohort assessed the number of visual field tests, OCTs, and the days of glaucoma prescription coverage over the year following the index date. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes. Inverse proportional treatment weighting was used to better balance baseline covariates between the dementia patients and matched controls.
Results :
POAG patients with dementia had a reduced rate of eye care visits (RR 0.765, 95% CI: 0.753-0.777), a lower rate of testing utilization for visual field (RR 0.656, 95% CI: 0.634-0.678) and OCT (RR 0.668, 95% CI: 0.642-0.694), and a lower rate of glaucoma prescription medication coverage (RR 0.830, 95% CI: 0.828-0.832). nAMD patients with dementia had a reduced rate of eye care visits (RR 0.744, 95% CI: 0.699-0.791) and received fewer intravitreal injections (RR 0.636, 95% CI: 0.583-0.693) than those without dementia.
Conclusions :
POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care. Future studies should examine the visual, cognitive, and functional consequences of the reduced eye care utilization in the dementia population.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.