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Multicenter Study
. 2024 Dec;262(12):3947-3955.
doi: 10.1007/s00417-024-06573-z. Epub 2024 Jul 12.

Disparities in glaucoma and macular degeneration healthcare utilization among persons living with dementia in the United States

Ali G Hamedani  1   2   3   4 , Angela Y Chang  5 , Yineng Chen  6 , Brian L VanderBeek  5   7   8
Affiliations
Multicenter Study

Disparities in glaucoma and macular degeneration healthcare utilization among persons living with dementia in the United States

Ali G Hamedani et al. Graefes Arch Clin Exp Ophthalmol. 2024 Dec.

Abstract

Purpose: Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia.

Methods: Optum's de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes.

Results: POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75-0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63-0.68) and OCT (RR 0.67, 95% CI: 0.64-0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83-0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70-0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58-0.69) than those without dementia.

Conclusions: POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.

Keywords: Dementia; Disparities; Glaucoma; Healthcare utilization; Macular degeneration.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Pennsylvania Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Summary of inclusion and exclusion criteria
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