Better health equity needed to improve visual outcomes
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FORT LAUDERDALE, Fla. — Social and political determinates of health must be addressed to provide all patients with better visual outcomes, according to a speaker at the Retina World Congress.
Judy E. Kim, MD, said about half of a patient’s determinates of health are related to socioeconomic factors and physical location.
“As doctors, we think that we have lots of influence on the health of a patient, but health care only comprises 20% as a determinate of health,” she said.
Previous research has shown that adults with lower socioeconomic status are disproportionately affected by diabetes, and patients with lower levels of education had the highest risk, Kim said.
In eye care, diabetic retinopathy disproportionately affects Black Americans compared with white Americans (32.2 per 1,000 vs. 24.1 per 1,000). Additionally, the prevalence of diabetic macular edema among Black Americans is three times greater than in white Americans. In fact, Kim said that race is more of a factor in determining the development of DME than HbA1c levels.
There is a difference in how patients are treated for their retinal diseases and in their outcomes after treatment, Kim said. In an electronic medical record study at the Cleveland Clinic, despite similar baseline visual acuity, white patients had better visual acuity after anti-VEGF treatment compared with Black patients. White patients also received a greater number of injections over a 1-year period. Other real-world evidence showed that Black patients with DME were less likely to experience visual acuity improvements after undergoing treatment with bevacizumab compared with white patients.
Gender disparities also exist in retina care, with women being less likely to receive surgical intervention for rhegmatogenous retinal detachment and more often experiencing a delay in intervention. Kim said the differences could be due to access to care, societal gender roles and biological differences in rhegmatogenous retinal detachment types.
“We have to accept that eye health disparities exist, and it results in poorer visual outcomes for our patients,” she said. “Addressing these social determinants of health will allow our patients to take full potential of their health while seeing for a lifetime.”
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Kim JE. DEI aspects of retinal diseases. Presented at: Retina World Congress; May 9-12, 2024; Fort Lauderdale, Florida.
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