Socioeconomic status and visual outcome in patients with neovascular age-related macular degeneration

Abstract

Purpose Visual outcome in patients with neovascular age-related macular degeneration is variable. We aimed to evaluate for association between socioeconomic status visual acuity in neovascular age-related macular degeneration. Methods A retrospective single-center study of a consecutive group of neovascular age-related macular degeneration patients was performed. Socioeconomic status was determined for each patient based on the 2008 Israeli census. Medical information was extracted from medical records and included visual acuity and optical coherence tomography parameters. Associations between socioeconomic status and clinical outcomes were analyzed. Results A total of 233 patients were included in the analysis. A correlation was found between low baseline visual acuity of the first eye diagnosed with neovascular age-related macular degeneration and low socioeconomic status (r = −0.13, p = 0.049; n = 233). The difference between the visual acuity of the lowest and the highest socioeconomic status categories at baseline was approximately 3 ETDRS lines (p = 0.048). Socioeconomic status and baseline visual acuity of the second eye of the same individual with neovascular age-related macular degeneration were not correlated (r = −0.05, p = 0.95). Socioeconomic status was not associated with the number of anti-vascular endothelial growth factor injections of the first or second eye, or the visual acuity outcome of the first or second eye after 1 year of therapy (p = 0.421, p = 0.9, respectively). Central subfield thickness of the first eye at presentation as measured by spectral-domain optical coherence tomography was associated with socioeconomic status (r = −0.31 p = 0.001). Conclusion Individuals of lower socioeconomic status presented at more advanced stage of the disease when developing neovascular age-related macular degeneration in the first eye but not in the second eye. The research underscores the importance of improving referral patterns and awareness for the lowest socioeconomic status classes.

Insights Into Eye Care Accessibility: Geospatial Distribution of Eye Care Providers and Socioeconomic Factors by ZIP Code

“…This includes those who focus on private-pay patients or work in non-traditional settings. The number of ophthalmologists in this study (17,631) accounted for over 90% of total actively practicing ophthalmologists (18,948) in the United States as reported by the Association of American Medical Colleges in 2022. 30 The number of optometrists in this study (30,318), however, represented only 82% of the estimated total number of optometrists reported by the U.S. Bureau of Labor Statistics in 2020 (36,690).…”

“…11 Smaller scale studies have specifically demonstrated associations between SES factors and the prevalence of certain pathologies such as childhood strabismus, 12 glaucoma, [13][14][15][16] cataracts, 17 and macular degeneration. 18 In the United States, ZIP Codes and their equivalent geocodes have long been used to collect data in relation to geographic communities providing more precise and granular demographic data to understand local trends. Research has shown disparities spanning across economic, environmental, educational, and health factors related to geographic location.…”

Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

“…Overall, greater neighborhood-level SVI is associated with a greater likelihood of non-adherence to ophthalmology appointments, and the largest difference in adherence was observed with the socioeconomic status SVI theme. Low socioeconomic status is associated with a higher incidence of open globe injury, 25 presenting at a more advanced stage of age-related macular degeneration, 26 a greater risk of developing glaucoma, 27 and higher rates of blindness. 28 Residency in more disadvantaged neighborhoods is associated with poor adherence to both diabetic retinopathy screening 29, 30 and physician recommended urgent ophthalmology appointments.…”