More Equitable Access to Care Needed for AMD Patients | AAO 2024

Targeted interventions are needed to enhance access to eye care services in lower-income communities for patients with age-related macular degeneration (AMD), say researchers of a new study of economic disparities among patients with AMD. The research was presented in a poster at the annual meeting of the American Academy of Ophthalmology, taking place this week in Chicago.

Age-related macular degeneration is a condition that affects the macula, the part of the eye that provides the vision needed for activities such as reading, and it is a leading cause of blindness for people aged 60 and over in the United States. In 2019, an estimated 19.8 million (12.6%) Americans aged 40 and older were living with age-related macular degeneration, according to data published in JAMA Ophthalmology.

Ji Yun Han

Researchers, led by Ji Yun Han, an M.D. student at The Warren Alpert Medical School of Brown University, searched data from the National Institutes of Health All of Us program, a nationwide database that began in 2018. They searched for patients with vision-threatening AMD who were 65 years of age and older. Metrics for patients’ eye care utilization were documented from 6 months to 5 years after first recorded diagnostic code for eye exams, intravitreal injections, peripheral fundus exams (to assess the back of the eye), macular optical coherence tomography (uses light waves to take cross-section picture of the retina) and fluorescein angiograph (uses contrast dye to look at the retina).

They stratified patients by income and analyzed records for 490 patients with annual income of more than $100,000, 511 patients with income of between $50,000 and $100,000 and 652 patients with income of less than $50,000.

Researchers found that patients in the lowest-income group had reduced utilization of ophthalmic services than those in the higher-income groups. There were “notable disparities in the rates of eye examinations and advanced diagnostic procedures compared with those with higher incomes,” the researchers noted. “Low-income individuals are more likely to have worse outcomes and a higher burden with AMD.”

When compared with patients with an annual income above $100,000, patients with an annual income below $50,000 had a 43% lower rate of eye examinations, 77% lower utilization rate of fundus photography/examinations and 56% lower rate of macular OCT and fluorescein angiograph.

Researchers said in their poster presentation that the financial burden of treatment can lead to delayed or incomplete treatment and poor outcomes. They indicated that in underserved areas, there are fewer ophthalmologists and public healthcare settings have longer wait times and less frequent follow-up appointments compared with private practice.

They suggested that telehealth and remote monitoring of patients could address transportation barriers and reduce the need for frequent in-person visits.