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  • Insurance type affects visual acuity and severity of diabetic retinopathy outcomes

    Comprehensive Ophthalmology, Retina/Vitreous

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    Review of: Racial, ethnic, and insurance-based disparities upon initiation of anti–vascular endothelial growth factor therapy for diabetic macular edema in the US

    Malhotra N, Greenlee T, Iyer A, et al. Ophthalmology, October 2021

    Using the IRIS registry, researchers found disparities in outcomes for patients with diabetic retinopathy (DR) based on insurance status, race, and other factors.

    Study design

    In this retrospective, cross-sectional study, multivariate regression analyses were performed using IRIS Registry data from 203,673 adult patients who initiated anti-VEGF therapy for diabetic macular edema (DME) to study the impact of race, ethnicity, insurance status, and geographic location.

    Outcomes

    There was a higher baseline visual acuity in patients with Medicare and private insurance compared with patients with Medicaid (median of 2.31 and 4.17 greater ETDRS letters, respectively). White and non-Hispanic patients presented with better visual acuity compared with their counterparts (median of 0.68 and 2.53 greater ETDRS letters, respectively), and Black and Hispanic patients had worse baseline DR severity  (odds ratio, 1.23 and 1.71, respectively). There was a statistically significant difference in insurance status when further broken down by race and ethnicity.

    Limitations

    Due to the limitations of the IRIS Registry, the role of socioeconomic and diabetic control factors that may have contributed to the differences was not able to be studied.

    Clinical significance

    Public health efforts are needed to address the disparities in race and insurance-based differences in patients with DME. Further studies may elucidate the interaction of socioeconomic and diabetic control factors with race and insurance status on baseline vision and treatment outcomes.