Q&A: Understanding the impact of socioeconomic disparities in AMD
Click Here to Manage Email Alerts
Key takeaways:
- Studies have shown that socioeconomic factors can lead to worsened outcomes in patients with AMD.
- Providers should be mindful of the impact of socioeconomic status when caring for patients.
Healio spoke with Bradley Dougherty, OD, PhD, associate professor at The Ohio State University College of Optometry, about how socioeconomic factors can affect the diagnosis, treatment and outcomes of age-related macular degeneration.
Healio: What socioeconomic factors can contribute to inequities in AMD treatment and outcomes?
Dougherty: There are a number of potential barriers to obtaining treatment for AMD that may be associated with lower socioeconomic status, or SES. These include a lack of transportation to visits with eye care specialists, lack of health insurance and financial burdens. One of the ways in which some of these barriers could result in poor treatment outcomes is that they result in patients seeking treatment later in the disease process, when perhaps the prognosis is poorer.
Work in our lab also showed an association between low SES and missed follow-up appointments in people with neovascular AMD, which could result in missed anti-VEGF treatments and worse outcomes. A good review of barriers to care in neovascular AMD was published this year by Choi and colleagues in Survey of Ophthalmology.
Healio: What socioeconomic factors are associated with a patient’s risk for developing AMD?
Dougherty: Multiple studies have found that lower levels of educational attainment are associated with increased risk for the development of AMD. In the U.S., the Beaver Dam Eye Study also showed that workers of blue-collar jobs had a higher risk for developing AMD compared with white-collar workers (Wong et al).
Healio: How can clinicians help mitigate the effects of these socioeconomic disparities in patients with AMD?
Dougherty: Many of the reasons that low SES is associated with poor health outcomes generally are larger than just patient interactions with clinicians. We should, as a society, work hard to address these. However, clinicians can be mindful of the role that SES can play when delivering eye care in ways that are beneficial to their patients. Just being inquisitive about why a particular patient missed a follow-up exam could result in ideas about how to address that barrier for the future — and perhaps for other patients as well.
Some other possibilities include ensuring that patients have a good understanding of AMD, its treatment and required follow-up care through in-person communication during exams, trying to accommodate patients with transportation difficulties, considering acceptance of a wider range of insurances and connecting patients to social workers or other patient care advocates.
The American Academy of Ophthalmology Task Force on Disparities in Eye Care recently published an excellent position statement that covers much of this (Elam et al).
Healio: How does access to care differ in lower vs. higher socioeconomic areas?
Dougherty: Access to care is complicated and multifaceted, but generally speaking people living in low-income and rural areas have less access to eye care providers. This is consistent with recent findings from my colleagues at Ohio State, Erica Shelton, OD, MS, and Dean VanNasdale, OD, PhD, that nonmetro, rural U.S. counties have the highest rates of vision impairment.
Healio: What additional research is needed to evaluate socioeconomic factors and AMD outcomes?
Dougherty: There is plenty to investigate. Given the potentially complicated interrelationships among various factors associated with socioeconomic status, access to care and outcomes, we should continue to conduct research to better understand what factors result in loss of vision from AMD and other eye diseases with similar relationships.
There is also tremendous opportunity to explore the effects of various interventions that target risk factors associated with low SES. Some of these interventions could include novel eye health literacy programs, clinic transportation solutions, telehealth programs or establishment of clinic locations for people in underserved areas.
Healio: What is the importance of addressing health equity in AMD and other eye diseases?
Dougherty: The Optometric Oath requires optometrists to “work to expand access to quality care and improve health equity for all communities.” We have a duty to understand the factors that prevent our patients from achieving the best outcomes and attempt to address them. Better visual outcomes for people with AMD are likely to lead to better quality of life, better mental health, continued ability to drive and generally more productive lives.
References:
- Choi A, et al. Surv Ophthalmol. 2024;doi:10.1016/j.survophthal.2023.09.001.
- Ethics & Values: The Optometric Oath. https://www.aoa.org/about-the-aoa/ethics-and-values?sso=y. Accessed July 23, 2024.
- Elam AR, et al. Ophthalmology; 2022;doi:10.1016/j.ophtha.2022.07.010.
- VanNasdale DA, et al. Ohio J Public Health. 2022;doi:10.18061/ojph.v5i1.8685.
- Wong TY, et al. Ophthalmology. 2000;doi:10.1016/s0161-6420(00)00390-0.
Collapse
Healio Interviews
Read more about
Click Here to Manage Email Alerts