Social determinants of eye health in the United States: a suite of systematic reviews

Abstract

Purpose : Considerable evidence suggests that social determinants of health (SDOH) are critical in the prevalence, diagnosis, and outcomes of vision health and eye disease across the life course. Yet, the literature on social determinants of eye health in the United States (US) has not been systematically summarized. Our objective is to identify, assess, and synthesize the literature on (1) vision health disparities and SDOH and (2) the effectiveness of interventions targeting amelioration of SDOH in the US.

Methods : We searched MEDLINE, Embase, and Web of Science from 01/2000-11/2022. We included primary studies that examined any of the five SDOH domains outlined by the Healthy People 2030 framework (see Results). We dual-screened each record at title/abstract and full-text levels. Eligible full-text reports were coded by disease, SDOH domain, study design, and age group to divide into systematic reviews. Review groups extracted data on the populations, interventions, exposures, outcomes; and assessed the risk of bias using tools appropriate to the design. We synthesized results using narratives, tables, and figures. We followed Cochrane’s guidance on alternative synthesis methods when meta-analysis was not feasible.

Results : We identified 31,901 records and included 922 primary studies (135 interventional, 787 observational). Studies often addressed multiple SDOH domains: 406 (44%) economic stability, 304 (33%) education access and quality, 507 (55%) healthcare access and quality, 406 (44%) neighborhood and built environment, and 498 (54%) social and community context. The most frequent conditions were refractive errors (138, 15%), glaucoma (120, 13%), diabetic eye disease (119, 13%), and low vision (102, 11%). Systematic reviews of ocular neoplasia (29 studies), retinopathy of prematurity (22 studies), and pediatric vision screening (120 studies) are ongoing. A review of dry eye (pending publication) included 18 studies assessing 51 potential indicators of SDOH. A substantial portion concentrating on the impact of climate or air quality measures on dry eye.

Conclusions : Conducting a suite of systematic reviews enables a thorough investigation of the current literature, highlighting areas for developing implementation strategies to promote equity in eye health in the US while identifying gaps in research and practice.

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