Racial, Ethnic, and Insurance-Based Disparities Upon Initiation of Anti-VEGF Therapy for Diabetic Macular Edema in the United States

Abstract Purpose This study characterizes the association of risk factors including race, ethnicity, and insurance status with presenting visual acuity (VA) and diabetic retinopathy (DR) severity in patients initiating treatment with anti-vascular endothelial growth factor (VEGF) therapy for Diabetic Macular Edema (DME). Design Retrospective cross-sectional study Participants The Academy IRIS® Registry (Intelligent Research in Sight) database was queried for patients who initiated anti-VEGF injection treatment for DME between 2012 and 2020 (n=203707). Methods Multivariate regression analyses were conducted to understand how race, ethnicity, insurance status, and geographic location were associated with baseline features. Main Outcome Measures VA and DR severity Results Patients on Medicare and private insurance presented with higher baseline VA compared to patients on Medicaid (median of 2.31 and 4.17 greater ETDRS (Early Treatment Diabetic Retinopathy Scale) letters, respectively p Conclusions There are ethnic and insurance-based disparities in VA and disease severity upon initiation of anti-VEGF therapy for DME treatment. Public health initiatives could improve timely initiation of treatment.