The impact of socioeconomic deprivation on anti-VEGF therapy and ocular response in patients with diabetic macular edema

Abstract

Purpose : The Area Deprivation Index (ADI) is a validated composite measure of socioeconomic status (SES), in which higher percentiles correspond with lower SES. ADI has previously been associated with treatment outcomes in viral retinitis and branch retinal vein occlusion. This study sought to assess differences in anti-vascular endothelial growth factor (anti-VEGF) therapy and treatment response across national ADI scores in patients with diabetic macular edema (DME).

Methods : This was a single-center retrospective review of patients diagnosed with DME between 2014 and 2022 who received at least one anti-VEGF injection within 24 months of diagnosis. Best corrected visual acuity (BCVA), central foveal thickness (CFT), and macular volume (MV) were measured at 6-month intervals from DME diagnosis. Patients were classified as “low ADI” (higher SES) or “high ADI” (lower SES) using the 75^th national ADI percentile as a cutoff. Student t-test and χ² analyses were used to compare continuous and categorical variables, respectively.

Results : 187 eyes from 117 patients met the inclusion criteria for this study. 59 patients comprised the high ADI group and 58 patients comprised the low ADI group. Groups were similar in age (p=0.95), HbA1c (p=0.83), and BMI (p=0.33). There were no significant differences in mean BCVA, CFT, and MV between groups at baseline (p>0.05). Baseline ocular characteristics were also comparable across all measures, including lens status and stage of diabetic retinopathy (p>0.05).

At the 24 month follow up, mean BCVA was 0.856 ± 0.673 logMAR in the high ADI group and 0.511 ± 0.561 logMAR in the low ADI group (p=0.002). Mean final CFT and MV were not significantly different between groups (p>0.05). 48 and 59 eyes in the high and low ADI groups, respectively, were pseudophakic at the 24 month follow up (p=0.03). Patients in the high ADI group received a mean of 7.0 ± 6.4 injections during the 24 month treatment period, compared to 5.8 ± 5.4 injections in the low ADI group (p=0.4).

Conclusions : BCVA was worse in the high ADI group at the end of the 24 month follow up period. This was likely driven by socioeconomically advantaged patients being more likely to receive cataract surgery during the treatment period, since there were no significant differences in CFT, MV, and anti-VEGF therapy between groups.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.