Crisis Point: Improving Health Equity in Eye Care

This is Crisis Point.

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is when an emergency worsens or begins to get better, the question remains: where are we now?

This episode addresses disparities in ophthalmic care across the United States, from gaps in diagnosis codes and high rates of glaucoma among minority populations to the associations between unstable housing and visual impairment.

For more insight, we spoke with 3 professionals in ophthalmology:

• Kaela Acuff, a fourth-year medical student at the University of California, San Diego
• Paul Anne Newman-Casey, MD, MS, an assistant professor in the department of ophthalmology and visual sciences, University of Michigan
• Theodore Leng, MD, an associate professor of ophthalmology at the Byers Eye Institute, Stanford University School of Medicine

Led by Acuff, the investigative team from UCSD analyzed patterns of diagnosis code usage and epidemiology patterns of glaucoma onset and severity among patients with glaucoma using the National Institutes of Health All of Us database.

The investigative team found among nearly 3000 participants, only 57% had unspecified severity staging. Black Hispanic/Latino and other minority participants were diagnosed with glaucoma at significantly younger ages, compared with White participants. Black participants were also shown to have a greater likelihood of more severe disease, even after adjustments for socioeconomic status.

Using cross-sectional data from the MI-SIGHT Community Eye Disease Screening Program, Newman-Casey’s team investigated an association between housing and food insecurity with vision and ophthalmic pathology. They identified visual impairment in 10.3% of participants and uncorrected refractive error in 8.3% of participants; 3.4% reported housing insecurity and 28.9% reported food insecurity.

Among those with unstable housing, 26.3% had visual impairment and 23.7% had uncorrected refractive error. Unstable housing was associated with a higher likelihood of visual impairment (odds ratio [OR], 3.53; P = .006) and uncorrected refractive error (OR, 3.74; P = .006). There were no other associations observed between unstable housing and other ocular pathologies, or between food insecurity and any ocular pathology.

Finally, Leng spoke about the benefit of collecting real-world data on retinal diseases. He noted after applying clinical trial inclusion and exclusion criteria, approximately half of the patients with a disease like neovascular age-related macular degeneration actually qualify for a trial. For the other subset of patients, there is no guidance on how those patients respond to treatment, making real-world data on treatment needs and gaps crucial to effectively treat that population.

If you want more video content, visit our Crisis Point page for other episodes on disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

References

1. ^{Acuff K, Radha Saseendrakumar B, Wu JH, Weinreb RN, Baxter SL. Racial, Ethnic, and Socioeconomic Disparities in Glaucoma Onset and Severity in a Diverse Nationwide Cohort in the United States. J Glaucoma. 2023;32(9):792-799. doi:10.1097/IJG.0000000000002261}
2. ^{Johnson-Griggs MA, Hicks PM, Lu MC, et al. The Relationship between Unstable Housing, Food Insecurity and Vision Status in the MI-SIGHT Community Eye Disease Screening Program [published online ahead of print, 2023 Sep 12]. Ophthalmology. 2023;S0161-6420(23)00668-1. doi:10.1016/j.ophtha.2023.09.011}
3. ^{Iapoce C. Theodore Leng, MD: Real-world Faricimab use in Faretina-AMD Study. HCP Live. August 4, 2023. Accessed October 5, 2023. https://www.hcplive.com/view/theodore-leng-md-real-world-faricimab-use-faretina-amd-study.}
4. ^{Crisis point. HCPLive. Accessed July 13, 2023. https://www.hcplive.com/shows/crisis-point}
5. ^{Enoch J, McDonald L, Jones L, Jones PR, Crabb DP. Evaluating Whether Sight Is the Most Valued Sense. JAMA Ophthalmol. 2019;137(11):1317–1320. doi:10.1001/jamaophthalmol.2019.3537}