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Heinze N, Jones L. Access to eye care and support services among adults from minority ethnic communities living with visual impairment in the United Kingdom. Front Public Health 2024; 11:1277519. [PMID: 38259735 PMCID: PMC10800624 DOI: 10.3389/fpubh.2023.1277519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal. Methods This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22). Results There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040. Conclusion The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.
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Affiliation(s)
| | - Lee Jones
- BRAVO VICTOR, Research, London, United Kingdom
- UCL, Institute of Ophthalmology, London, United Kingdom
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Zang B, Rong S, Li D, Ding X, Zang D, Wang F, Liang Y, Zhai G, Feng K, Zhou Z, Wang Y. Undiagnosed diabetic retinopathy in Northeast China: prevalence and determinants. Front Endocrinol (Lausanne) 2023; 14:1263508. [PMID: 38093961 PMCID: PMC10716530 DOI: 10.3389/fendo.2023.1263508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Objective To report the prevalence and contributing factors of undiagnosed diabetic retinopathy (DR) in a population from Northeastern China. Subjects/Methods A total of 800 subjects from the Fushun Diabetic Retinopathy Cohort Study were enrolled. A questionnaire assessing incentives and barriers to diagnosis of DR was administered. Logistic regression was used to identify clinical and sociodemographic factors associated with undiagnosed DR. In a prespecified subgroup analysis, we divided patients into vision-threatening diabetic retinopathy (VTDR) and non-VTDR (NVTDR) subgroups. Results Among 800 participants with DR, 712 (89.0%) were undiagnosed. Among 601 with NVTDR, 566 (94.2%) were undiagnosed. Among 199 with VTDR, 146 (73.4%) were undiagnosed. The risk factors affecting the timely diagnosis of NVTDR and VTDR exhibit significant disparities. In multivariate models, factors associated with undiagnosed VTDR were age over 60 years (OR = 2.966; 95% CI = 1.205-7.299; P = 0.018), duration of diabetes over 10 years (OR = 0.299; 95% CI = 0.118-0753; P = 0.010), visual impairment or blindness (OR = 0.310; 95% CI = 0.117-0.820; P = 0.018), receiving a reminder to schedule an eye examination (OR = 0.380; 95% CI = 0.163-0.883; P = 0.025), and the belief that "people with diabetes are unlikely to develop an eye disease" (OR = 4.691; 95% CI = 1.116-19.724; P = 0.035). However, none of the factors were associated with undiagnosed NVTDR (all P ≥ 0.145). Conclusion Our research has uncovered a disconcerting trend of underdiagnosis in cases of DR within our population. Addressing determinants of undiagnosed DR may facilitate early detection.
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Affiliation(s)
- Bo Zang
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Shisong Rong
- Mass Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA, United States
| | - Dong Li
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Xiaoxia Ding
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Dongxiao Zang
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Fenghua Wang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yuanbo Liang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Gang Zhai
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Kemi Feng
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zixi Zhou
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Yu Wang
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
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Buscho SE, Sharifi A, Cayenne S, Zhang Y, Merkley KH, Gupta PK. Racial Disparities in Cataract Surgery Timeline and Intraocular Lens Selection: A Retrospective Study. Transl Vis Sci Technol 2023; 12:20. [PMID: 37975843 PMCID: PMC10668610 DOI: 10.1167/tvst.12.11.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
Purpose There is a significant amount of literature focusing on racial inequities in utilization rates and intraoperative complications of cataract surgery. Unfortunately, little is known about racial disparities regarding the timeline of cataract surgery and intraocular lens (IOL) selection. This study investigated whether black patients have a different preoperative and postoperative cataract surgery timeline and IOL selection than white patients. Methods A total of 10,235 patients (83.47% white) were retrospectively identified from a tertiary academic center who underwent cataract surgery between 2015 and 2022. Each patient's best corrected visual acuity (BCVA), slit lamp findings, and surgical timeline were recorded. IOL selection was categorized as standard or premium. Results Black patients had significantly worse mean ± SD preoperative logMAR BCVA than white patients (0.47 ± 0.55 vs. 0.58 ± 0.70, respectively; P = 0.0117) and were significantly less likely to receive surgery within 120 days of referral (RR, 0.71 [95% confidence interval {CI}, 0.64-0.79]; P < 0.0001). White patients were 25%, 24%, and 29% less likely to follow-up than black patients at postoperative day 1, day 7, and day 30, respectively (P < 0.0001). White patients were 6.09 (95% CI, 3.49, 10.63) times more likely to receive a premium IOL compared to black patients (P < 0.0001). Conclusions Black patients experienced more delays with receiving cataract surgery but are more adherent with postoperative follow-up. Black patients were far less likely to receive a premium IOL than white patients. Translational Relevance Increased awareness of racial inequities in cataract surgery may improve the delivery of eye care to minority groups.
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Affiliation(s)
- Seth E Buscho
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ardalan Sharifi
- Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Samir Cayenne
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yuanyi Zhang
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Kevin H Merkley
- Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Praveena K Gupta
- Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, Galveston, Texas, USA
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Laviers H, Papavasileiou E, Bruce C, Maubon L, Radia M, Dervenis N, Zuckerman B, Loh GK, Theodorou O, Douiri A, Zambarakji H, Sandinha T, Steel DH, Kirthi V, McKechnie C, Zakir R, Duguid G, Jackson TL. The effect of ethnicity on anatomic success following macular hole surgery: a multicentre cohort study. Graefes Arch Clin Exp Ophthalmol 2023; 261:1535-1543. [PMID: 36602644 DOI: 10.1007/s00417-022-05950-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/29/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose is to assess the effect of ethnicity on surgical macular hole closure. METHODS A retrospective cohort study was undertaken in five UK National Health Service Hospitals. We included all patients with known ethnicity undergoing vitrectomy, internal limiting membrane peel, and gas/oil tamponade for all stages of primary full-thickness macular hole (FTMH). The primary outcome was anatomic success, defined as FTMH closure with one operation. The secondary outcome was mean change in best-corrected visual acuity (BCVA) comparing baseline with final review. RESULTS Of 334 operations, the ethnicity profile comprised 78.7% White patients, 11.7% Black patients, 8.1% Asian patients, and 1.5% in mixed/other ethnicities. Mean age was 69.7 years with 68.5% females. Overall, 280 (83.8%) had anatomic success. Anatomic failure occurred in 38.5% of Black patients versus 12.6% of White patients (relative risk: 1.788; 95% CI: 1.012 to 3.159; P = 0.045). Overall, baseline logarithm of the minimum angle of resolution BCVA improved by 0.34, from 0.95 (95% CI: 0.894 to 1.008) to 0.62 (95% CI: 0.556 to 0.676). Mean BCVA improved by 0.35 in White patients, 0.37 in Black patients, 0.23 in Asian patients, and 0.38 in mixed/other ethnicity (P = 0.689). Greater FTMH minimum linear diameter was associated with an increased risk of anatomic failure (relative risk: 1.004; 95% CI: 1.002 to 1.005; P < 0.0001), whereas better pre-operative BCVA (F [1,19] = 162.90; P < 0.0001) and anatomic success (F [1,19] = 97.69; P < 0.0001) were associated with greater BCVA improvement. Socio-economic status did not significantly influence anatomic success or BCVA change. CONCLUSIONS Black ethnicity is associated with an approximately twofold greater risk of failed FTMH surgery. The reasons for this difference warrant further study.
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Affiliation(s)
- Heidi Laviers
- Moorfields Duke Elder Eye Unit, St. George's University Hospitals NHS Foundation Trust, SW17 0QT, London, UK.
| | | | | | - Laura Maubon
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Meera Radia
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Nikolaos Dervenis
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Benjamin Zuckerman
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
| | | | | | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Hadi Zambarakji
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Teresa Sandinha
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - David H Steel
- Sunderland Eye Infirmary, NHS Trust, Sunderland, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Varo Kirthi
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Science and Medicine, King's College London, London, UK
| | - Cordelia McKechnie
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Rahila Zakir
- Western Eye Hospital, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Timothy L Jackson
- Department of Ophthalmology, Kings College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Science and Medicine, King's College London, London, UK
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Dinah C, Myers S, Pushpoth S, Degli-Esposti S. Revisiting NICE guidelines for initiation of intravitreal anti-VEGF therapy for centre-involving diabetic macular oedema: a survey of current interpretation in the United Kingdom. Eye (Lond) 2022; 36:1832-1834. [PMID: 35079161 PMCID: PMC9391462 DOI: 10.1038/s41433-022-01935-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christiana Dinah
- Department of Ophthalmology, London North West University Healthcare NHS Foundation Trust, London, UK.
| | - Sam Myers
- Department of Ophthalmology, London North West University Healthcare NHS Foundation Trust, London, UK
| | - Sreekumari Pushpoth
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Simona Degli-Esposti
- Medical Retina Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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Kirthi V, Jackson TL. Black eyes matter-do we treat Black patients differently in ophthalmology? Eye (Lond) 2021; 35:2662-2664. [PMID: 33958735 PMCID: PMC8100735 DOI: 10.1038/s41433-021-01567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Varo Kirthi
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK ,grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
| | - Timothy L. Jackson
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK ,grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
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