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  • Disparities at Initiation of Anti-VEGF Therapy for DME

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, October 2021

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    Although the risk factors for diabetic retinopathy (DR) and diabetic macular edema (DME) are fairly well under­stood, little is known about factors that are likely to stand in the way of prompt diagnosis and treatment of DME. Using data from the Academy’s IRIS Registry, Malhotra et al. looked at presenting visual acuity (VA) and disease severity in relation to ethnicity, geographic location, and insurance status. They hypothesized that these factors may im­pede early treatment of DME, leading to poor VA and greater disease severity by the time treatment is begun. Their findings corroborated this hypothesis.

    For this retrospective cross-sectional study, the authors gathered information for 203,707 patients who started anti-VEGF treatment of DME from 2012 through 2020. They performed multi­variate regression analyses to explore relationships between baseline clinical features and ethnicity, insurance status, and location. The main outcome mea­sures were VA and severity of DR.

    The majority of patients were White (58.5%). With respect to insurance, 32.2% had private plans, 22.9% had Medicare, and 8.8% had Medicaid. Baseline VA was better for patients with Medicare or private insurance than for those with Medicaid (median, 2.31 and 4.17 more ETDRS letters, respectively; p < .01). White and non-Hispanic patients had better VA than Blacks and Hispanics (median, 0.68 and 2.53 more ETDRS letters, respectively; p < .01). DR severity was worse for Black and Hispanic patients than for their counterparts (odds ratio [OR], 1.23 and 1.71, respectively; p < .01). Patients on Medicaid had a 1.19 OR of having DR severity one level higher than that of privately insured patients (p < .01); the difference between Medicaid and Medicare members was not significant.

    In this study, ethnicity and type of insurance status were independently linked to worse VA and greater DR severity. Hispanic ethnicity and Medicaid insurance had the strongest correlations with poor ophthalmic health. Such information may boost clinician awareness of the disparities that exist when anti-VEGF treatment of DME is begun, said the authors.

    The original article can be found here.