Disparities in Presentation and Anti-VEGF Therapy Initiation for Neovascular Age-Related Macular Degeneration: An Analysis of the Academy IRIS® Registry.

Purpose: To investigate disparities in presentation and initiation of anti-VEGF therapy among patients with neovascular age-related macular degeneration (nAMD).

Design: Retrospective cohort study.

Participants: Patients with nAMD newly diagnosed between October 2016 and October 2021 from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

Methods: Associations between demographic characteristics, presenting visual acuity (VA), and the initiation of anti-VEGF treatment were assessed using multivariable Poisson regression models.

Main outcome measures: Treatment initiation with ≥ 1 anti-VEGF injections within 12 months after first presentation with nAMD.

Results: Among the 918 759 patients with nAMD (61.5% female, 82.3% White), male, Black, and Hispanic patients demonstrated nAMD at younger ages (P < 0.001). Of these, 719 204 patients (78.3%) initiated anti-VEGF treatment within 1 year, with 71.1% of patients (653 340/918 759) receiving the first injection within 1 month. In multivariable regression analysis, Black patients (rate ratio [RR], 0.91; 95% confidence interval [CI], 0.89-0.93; P < 0.001) and Asian patients (RR, 0.95; CI, 0.93-0.97; P < 0.001) were less likely to initiate treatment compared with White patients. Hispanic patients were 4% less likely to initiate treatment than non-Hispanic patients (RR, 0.96; 95% CI, 0.95-0.98; P < 0.001). Patients older than 60 years (vs. those 50-59 years of age) were more likely to initiate treatment (P < 0.001 for all age group comparisons), as were patients from the West (vs. South) region (P < 0.001). Among 701 309 patients with VA data, patients with VA of worse than 20/40 to 20/200 were more likely to initiate treatment (RR, 1.14; 95% CI, 1.12-1.15) than those with 20/20 or better VA, whereas those with hand movements VA (RR, 0.72; 95% CI, 0.69-0.75) and light perception or worse VA (RR, 0.49; 95% CI, 0.44-0.54; all P < 0.001) were less likely to initiate treatment.

Conclusions: Over 20% of patients with nAMD did not initiate treatment within 1 year of presentation. Results suggest that lower treatment initiation rates are associated with Black and Asian race, Hispanic ethnicity, age younger than 60 years, and low-vision status. Efforts to improve treatment uptake might prioritize groups with lower initiation rates.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.