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Matsunaga K, Rajagopalan A, Nallasamy S, Nguyen A, de Castro-Abeger A, Borchert MS, Chang MY. Disparities in Amblyopia Treatment Outcomes: The Impact of Sociodemographic Factors, Treatment Compliance, and Age of Diagnosis. Ophthalmology 2024:S0161-6420(24)00569-4. [PMID: 39321931 DOI: 10.1016/j.ophtha.2024.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 09/27/2024] Open
Abstract
OBJECTIVE To identify clinical and sociodemographic factors associated with disparities in amblyopia treatment outcomes. DESIGN Retrospective chart review. SUBJECTS Children ≤8 years old diagnosed and treated for unilateral refractive or strabismic amblyopia at our institution from 2012-2022. METHODS Children with amblyopia were categorized by outcome: resolved amblyopia (<0.2 logMAR interocular difference [IOD] in visual acuity, or no fixation preference in non-verbal patients) or persistent amblyopia. Demographic and clinical data were recorded from the medical record. Zip codes were used to calculate Childhood Opportunity Index (COI) scores, estimated annual household income, and distance to hospital. MAIN OUTCOME MEASURES Sociodemographic and clinical factors were compared between children with resolved and persistent amblyopia. Factors significant at p<0.10 on univariate analysis were included in a multivariable regression model. RESULTS 168 patients met inclusion criteria, and 131 (78%) had resolved amblyopia. Demographic factors associated with resolution of amblyopia were younger age at diagnosis (3.3±1.7 vs. 4.5±1.9 years, p=0.0009), English as the primary language (79.4% vs. 62.2%, p=0.04), higher estimated annual income ($83,315.93±29,276.64 vs. $71,623.00±26,842.56, p=0.03), higher COI scores (50.9±27.3 vs. 40.0±26.4, p=0.03), and living further from our institution (28.6±37.6 vs. 14.9±12.7 miles, p=0.003). Patients with resolved amblyopia also had higher rates of treatment compliance (83.2±25.0% vs. 75.6±24.4%, p=0.009) and shorter delays in follow-up (40.1±76.8 vs. 61.1±90.4 days, p=0.02). Amblyopia persistence was borderline associated with governmental insurance and higher presenting IOD in visual acuity (both p=0.06). On multivariate analysis, only younger age at amblyopia diagnosis (p=0.0010) remained significantly associated with amblyopia resolution. CONCLUSIONS Our findings suggest that disparities in amblyopia outcomes are related to differences in age at diagnosis. Interventions to lower the age at which amblyopia is diagnosed, such as programs to improve vision screening rates and access to pediatric eye care in at-risk groups, may directly address inequities in rates of amblyopia resolution.
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Affiliation(s)
- Kate Matsunaga
- Department of Ophthalmology, University of Southern California, Los Angeles, CA
| | - Archeta Rajagopalan
- Department of Ophthalmology, University of Southern California, Los Angeles, CA
| | - Sudha Nallasamy
- Department of Ophthalmology, University of Southern California, Los Angeles, CA; Division of Ophthalmology, Children's Hospital Los Angeles (CHLA), Los Angeles, CA
| | - Angeline Nguyen
- Department of Ophthalmology, University of Southern California, Los Angeles, CA; Division of Ophthalmology, Children's Hospital Los Angeles (CHLA), Los Angeles, CA
| | - Alexander de Castro-Abeger
- Department of Ophthalmology, University of Southern California, Los Angeles, CA; Division of Ophthalmology, Children's Hospital Los Angeles (CHLA), Los Angeles, CA
| | - Mark S Borchert
- Department of Ophthalmology, University of Southern California, Los Angeles, CA; Division of Ophthalmology, Children's Hospital Los Angeles (CHLA), Los Angeles, CA
| | - Melinda Y Chang
- Department of Ophthalmology, University of Southern California, Los Angeles, CA; Division of Ophthalmology, Children's Hospital Los Angeles (CHLA), Los Angeles, CA.
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Hekmatjah N, Turner CH, Mesfin Y, Zhang L, Han Y, O'Brien KS, Oatts JT. Factors associated with pediatric ophthalmology follow-up adherence before and during the COVID-19 pandemic. J AAPOS 2024; 28:103963. [PMID: 38955242 DOI: 10.1016/j.jaapos.2024.103963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Studies describe poor follow-up among children in ophthalmology prior to the COVID-19 pandemic. Although the pandemic led to worse adherence for routine medical care in children, little information exists on pediatric ophthalmology follow-up adherence during COVID-19. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on follow-up adherence for children with eye disease, and identified characteristics associated with follow-up adherence. METHODS In this single-center study, the medical records of 519 new pediatric (≤18 years of age) patients seen during January, April, August, and December 2019 and 2021 were reviewed retrospectively. Patients were classified into two groups: adherent (patients who followed up within 30 days of recommended appointment time) or less-adherent (patients who followed up >30 days after recommended follow-up or never). Main outcome measure was patient adherence status. RESULTS Follow-up adherence was similar before and during the COVID-19 pandemic (50.4% for 2019 and 49.6% for 2021 [P = 0.40]). Patients that were less likely to be adherent in both univariate and multivariable analyses included those with public insurance (adjusted OR = 0.63 [95% CI, 0.40-1.00]; P = 0.05), and those recommended to follow-up ≥3 months (adjusted OR ≤ 0.10; P < 0.001). In addition, in univariate analysis, those who declined to self-report race (OR = 0.53 [95% CI, 0.29-0.95]; P = 0.04) and those seen by optometrists (OR = 0.42 [95% CI, 0.29-0.60]; P < 0.001) were less likely to be adherent, while patients who traveled ≥177 miles to their provider were more likely to be adherent (OR = 2.88 [95% CI, 1.17-7.55]; P = 0.02). CONCLUSIONS Follow-up adherence for childhood eye care was low but remained relatively stable before and during the COVID-19 pandemic; >50% of children were less-adherent.
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Affiliation(s)
- Natan Hekmatjah
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Charis Hoppe Turner
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Yeabsira Mesfin
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Li Zhang
- Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Kieran S O'Brien
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Julius T Oatts
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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Gaier ED, Chinn RN, Wilkinson CL, Hunter DG. Reply. J AAPOS 2024; 28:103825. [PMID: 38266811 DOI: 10.1016/j.jaapos.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Eric D Gaier
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan N Chinn
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol L Wilkinson
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David G Hunter
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Chinn RN, Wilkinson CL, Staffa SJ, Michalak SM, Shoshany TN, Bishop K, Hunter DG, Gaier ED. Amblyopia treatment outcomes in patients with neurodevelopmental disorders. J AAPOS 2023; 27:276.e1-276.e8. [PMID: 37739211 PMCID: PMC10591796 DOI: 10.1016/j.jaapos.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To compare amblyopia treatment outcomes between patients with neurodevelopmental disorders and their typically developing peers. METHODS Of 2,311 patients diagnosed with amblyopia between 2010 and 2014 at Boston Children's Hospital, 460 met inclusion criteria (age 2-12 with anisometropic, strabismic, or mixed amblyopia [interocular difference (IOD) ≥2 lines]). Treatment and visual outcomes were analyzed according to neurodevelopmental status: neurodevelopmental delay (DD) versus typical development (TD). RESULTS The DD group (n = 54) and TD group (n = 406) were similar in demographics, amblyogenic risk factors, baseline visual measures, prescribed therapy, and adherence (P ≥ 0.10). Between-visit follow-up time was longer for the DD group (0.65 [0.42- 0.97] years) than for the TD group (0.5 [0.36-0.82] years; P = 0.023). IOD improved similarly in each group by the last visit (DD, -0.15 logMAR [-0.31 to -0.02]; TD, -0.2 logMAR [-0.38 to -0.1]; P = 0.09). Each group reached amblyopia resolution by the last visit at similar frequencies (DD, 23/54 [43%]; TD, 211/406 [52%]; P > 0.2). DD diagnosis did not independently influence amblyopia resolution (HR, 0.77; 95% CI, 0.53-1.12; P = 0.17), but each additional month of interval time between follow-up visits reduced the likelihood of resolution by 2.7% (HR, 0.67; 95% CI, 0.51-0.87; P = 0.003). CONCLUSIONS Patients with DD and those with TD responded similarly to amblyopia therapy; however, follow-up intervals were longer in patients with DD and correlated with the likelihood of persistent amblyopia, suggesting that greater efforts at assuring follow-up may benefit patients with DD.
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Affiliation(s)
- Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Carol L Wilkinson
- Harvard Medical School, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital Boston, Massachusetts
| | - Suzanne M Michalak
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Talia N Shoshany
- Harvard Medical School, Boston, Massachusetts; Wills Eye Hospital, Jefferson Medical Center, Philadelphia, Pennsylvania
| | - Kaila Bishop
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Nguyen AH, Davoudi S, Dong K, Bains A, Ness S, Subramanian ML, Siegel NH, Chen X. Socioeconomic Disparities in Patients Receiving Intravitreal Injections for Age-Related Macular Degeneration Amid the COVID-19 Pandemic. JOURNAL OF VITREORETINAL DISEASES 2023; 7:376-381. [PMID: 37701269 PMCID: PMC10311364 DOI: 10.1177/24741264231173771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Purpose: To determine the effects of socioeconomic factors on visit adherence and the resultant visual outcomes for patients receiving intravitreal injections for neovascular age-related macular degeneration during the COVID-19 pandemic. Methods: In this retrospective case-control study, medical records were reviewed to collect appointment attendance, age, sex, self-reported race/ethnicity, primary language, marital status, insurance, distance from clinic, and Area Deprivation Index (ADI), a measure of socioeconomic disadvantage. Multivariate regression models were created to determine differences in socioeconomic factors between individuals who attended (show group) and those who did not attend (no-show group) appointments. Results: The study enrolled 126 patients in the show group and 115 in the no-show group. On univariate analysis, nonadherence was significantly higher in non-White patients than in White patients (P = .04), urban sites than in suburban sites (P = 1.7 × 10-4), and non-English-speaking patients than in English-speaking patients (P = 4.0 × 10-3). The associations remained significant in multivariate analysis for non-English-speaking patients (P = .03) and urban-site patients (P = .01) after adjusting for age, sex, self-reported race/ethnicity, primary language, marital status, insurance, distance from clinic, site of visit, and ADI. At 6 months and 1 year, a 1-, 2-, and 3-line vision loss was significantly higher in the no-show group than in the show group on univariate and multivariate analysis after adjusting for age, sex, race, lens status, and presence of glaucoma and diabetic retinopathy. Conclusions: Non-English-speaking patients and urban-based patients were less likely to present for intravitreal injection appointments during the initial peak of the COVID-19 pandemic. This disparity translated to worse vision outcomes at 6 months and 1 year.
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Affiliation(s)
- Anh H. Nguyen
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston MA, USA
| | - Samaneh Davoudi
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston MA, USA
| | - Kaylin Dong
- Boston University School of Medicine, Boston, MA, USA
| | - Ashank Bains
- Boston University School of Medicine, Boston, MA, USA
| | - Steven Ness
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston MA, USA
| | - Manju L. Subramanian
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston MA, USA
| | - Nicole H. Siegel
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston MA, USA
| | - Xuejing Chen
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston MA, USA
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Adomfeh J, Chinn RN, Michalak SM, Shoshany TN, Bishop K, Hunter DG, Jastrzembski BG, Oke I. Association of Neighborhood Child Opportunity Index with presenting visual acuity in amblyopic children. J AAPOS 2023; 27:20.e1-20.e5. [PMID: 36581151 DOI: 10.1016/j.jaapos.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To demonstrate the use of a novel measure of neighborhood quality, the Child Opportunity Index (COI), for investigating health disparities in pediatric ophthalmology. METHODS This study included children 2-12 years of age from a registry of patients diagnosed with amblyopia at an urban pediatric hospital between 2010 and 2014. Children previously treated for amblyopia were excluded. Patient demographics, residential addresses, and logMAR visual acuities were collected. The association between visual acuity at presentation and COI was examined using linear mixed-effects models adjusting for individual-level factors, including age, sex, race, ethnicity, and insurance type. RESULTS This study included 1,050 amblyopic children, of whom 317 (37%) were non-White and 149 (19%) were Hispanic; 461 (44%) had public insurance. Regarding residence, 129 (12%) lived in areas of very low opportunity (COI <20); 489 (47%) in areas of very high opportunity (COI ≥80). Children residing in the lowest opportunity neighborhoods correctly identified approximately two fewer letters at presentation with their better-seeing eye compared with children from the highest opportunity neighborhoods after adjusting for individual-level factors (-0.0090 logMAR per 20 unit increase in COI; 95% CI, -0.0172 to -0.0008; P = 0.031). No difference was appreciated in the worse-seeing eye. CONCLUSIONS Amblyopic children residing in communities with low neighborhood opportunity had slightly worse visual acuity in the better-seeing eye at presentation. Although statistically significant in the better-seeing eye, the two-letter difference attributable to neighborhood environment may not be clinically significant, and the impact of this disparity on treatment outcomes deserves further investigation.
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Affiliation(s)
- Jean Adomfeh
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Suzanne M Michalak
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Byers Eye Institute, Stanford University, Palo Alto, California
| | - Talia N Shoshany
- Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Kaila Bishop
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - David G Hunter
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Benjamin G Jastrzembski
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Isdin Oke
- Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
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Adomfeh J, Jastrzembski BG, Oke I. Association of Race, Ethnicity, and Socioeconomic Status With Visual Impairment in Adolescent Children in the US. JAMA Ophthalmol 2022; 140:1006-1010. [PMID: 36107437 PMCID: PMC9478879 DOI: 10.1001/jamaophthalmol.2022.3627] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 08/26/2023]
Abstract
Importance Although racial, ethnic, and socioeconomic disparities in visual impairment have been described in adults, few studies have focused on the adolescent population, which may provide insight into the emergence of vision health inequities. Objective To describe visual health disparities among adolescent children in the US. Design, Setting, and Participants This was a cross-sectional study of adolescents from the 2005 to 2008 National Health and Nutrition Examination Survey. Participants were aged 12 to 18 years with a completed visual function questionnaire and eye examination. Data analyses were conducted from January 19 to July 20, 2022. Main Outcomes and Measures Outcomes included subjective (self-reported poor vision) and objective (visual acuity worse than 20/40 in the better-seeing eye) measures of visual function. Multivariable logistic and linear regression analyses were conducted to examine the association between the sociodemographic risk factors and each outcome, adjusting for age, sex, and other covariates. Results The 2833 included participants (mean [SD] age, 15.5 [2.0] years; 1407 female participants [49%]) represent a survey-weighted 57 million US adolescent children, of whom 14% were non-Hispanic Black participants (876), 11% were Mexican American participants (828), 63% were non-Hispanic White participants (816), and 11% were other race and ethnicity (313). A total of 5% of participants (266) were not US citizens, and 19% (773) had a family income below the poverty threshold. There were increased odds of self-reported poor vision among Black (odds ratio [OR], 2.85; 95% CI, 2.00-4.05; P < .001), Mexican American (OR, 2.83; 95% CI, 1.70-4.73; P < .001), and low-income (OR, 2.44; 95% CI, 1.63-3.65; P < .001) adolescent children. Similarly, there were increased odds of visual acuity worse than 20/40 in the better-seeing eye among Black (OR, 2.13; 95% CI, 1.41-3.24; P = .001), Mexican American (OR, 2.13; 95% CI, 1.39-3.26; P = .001), and non-US citizen (OR, 1.96; 95% CI, 1.10-3.49; P = .02) participants. Conclusions and Relevance In this nationally representative sample from 2005 to 2008, adolescent children identifying as Black, Mexican American, low-income, or non-US citizen were more likely to report poor subjective visual function and perform worse on objective visual acuity testing. A greater understanding of the underlying etiology of these disparities may yield opportunities for improving vision at the population level.
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Affiliation(s)
- Jean Adomfeh
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin G. Jastrzembski
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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