In patients with newly diagnosed neovascular age-related macular degeneration (nAMD), those with a severe reduction of visual acuity are more likely older, non-white and have lower incomes, a study by researchers at Wills Eye Hospital reports.

The retrospective cohort study enrolled 3,205 patients. Of these, 93% were white with an average age of 80 and an income of approximately $88,800. In the cohort, 21% presented with mild vision loss (≥20/40), 47% had moderate vision loss (20/50-20/200) and 32% were diagnosed with severe vision loss (<20/200).

The researchers also found patients without previous follow up for dry AMD were 2.25 times more likely to have severe vision loss on initial presentation than those with a history of checkups for their condition.

“These findings suggest that patients with a history of dry AMD have established eye care and may be more likely to follow up sooner if new visual symptoms develop,” the researchers wrote in their paper.

The positive association between AMD severity and socioeconomic status may be related to the higher prevalence of adverse lifestyle factors among patients with lower socioeconomic status, the researchers suggested. For example, smoking is known to be more prevalent in lower socioeconomic groups and could underlie the relationship between socioeconomic status and AMD, the study noted.

Looking at income, the study found the odds of severe vision loss at the initial nAMD presentation were greater among patients with regional incomes of $50,000 to $100,000 compared with patients earning more than $100,000.

Additionally, investigators reported the odds of severe vision loss at the initial nAMD presentation were greater among non-white patients compared with white patients.

Previous studies demonstrated racial minorities have lower rates of developing nAMD relative to whites; however, the current investigation suggests that when racial minorities do develop nAMD, they are more likely to present with a severe reduction in visual acuity at the initial presentation compared with white patients.

The reasons for these racial disparities may include variable rates of eye exams or compliance, the cost of anti-VEGF treatment, the need for continual access to clinics and perceived risks of therapy, the study noted. Still, the investigators said the reasons behind these disparities remain unclear, and further research is warranted.

Knowledge of these risk factors may guide clinicians to consider innovative methods to reach high-risk populations and improve patient outcomes, the researchers said. 

Patel SN, Wu C, Obeid A, et al. Sociodemographic factors in neovascular age-related macular degeneration. Ophthalmology. October 4, 2019. [Epub ahead of print].