Abstract
Purpose :
Diabetic retinopathy disproportionately affects groups from disadvantaged backgrounds regardless of glucose control. Although teleophthalmology improves diabetic retinopathy (DR) screening rates, the impact of socioeconomic status on retinal disease severity and eye care access is unknown. Here, we investigate whether socioeconomic condition as measured by Area of Deprivation Index (ADI) impacts prevalence and severity of ocular pathologies, and eye care follow-up after remote eye screening.
Methods :
We reviewed medical records of patients from University of California, Davis Health who underwent remote diabetic retinopathy screening between 2018-2022 to collect demographic data, medical history, teleophthalmology findings, and in-person eye care follow-up reports. ADI is a composite measure of income, education, employment, and housing, which has been used to inform health delivery and policy. Patients with no census neighborhood level data were excluded.
Results :
Among 1533 patients who underwent remote DR screening (mean age 61.5, 46.4% female, 11.9% Black, 16.1% Hispanic, mean HbA1c 7.6), most patients had no (78%) or mild DR (11.7%), while some had more than mild non-proliferative DR (2.1% moderate, 0.3% severe, 0.3% proliferative, 1.2% diabetic macular edema). Patients with greater socioeconomic disadvantage was associated with worse DR severity (p<0.001). For those who were referred for in-person eye care evaluation (n = 398), the most socioeconomically deprived individuals were also less likely to follow up within the recommended time frame (23.5% in 5th quintile vs. 65.6% in 1st quintile).
Conclusions :
Socioeconomic disadvantage as measured by ADI is independently associated with worse DR severity, and less likely to receive follow-up care within the recommended time frame after remote DR screening using teleophthalmology. Although remote DR screening improves overall screening rate, further investigation is needed to understand methods to best mitigate these disparities in prevalence, severity, and follow-up care.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.