Racial, Ethnic, and Insurance-Based Disparities Upon Initiation of Anti–Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in the US

Research Lead:

Nisha A. Malhotra, MPH Tyler E. Greenlee, DO Amogh I. Iyer, BS Thais F. Conti, MD Andrew X. Chen, BSE Rishi P. Singh, MD


This study characterizes the association of risk factors including race, ethnicity, and insurance status with presenting visual acuity (VA) and diabetic retinopathy (DR) severity in patients initiating treatment with anti–vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME).


Retrospective, cross-sectional study.


The Academy Intelligent Research in Sight (IRIS) Registry database was queried for patients who initiated anti-VEGF injection treatment for DME between 2012 and 2020 (n = 203 707).


Multivariate regression analyses were conducted to understand how race, ethnicity, insurance status, and geographic location were associated with baseline features.

Main Outcome Measures

Visual acuity and DR severity.


Patients on Medicare and private insurance presented with higher baseline VA compared with patients on Medicaid (median of 2.31 and 4.17 greater Early Treatment Diabetic Retinopathy Scale [ETDRS] letters, respectively P < 0.01). White and non-Hispanic patients presented with better VA compared with their counterparts (median of 0.68 and 2.53 greater ETDRS letters, respectively; P < 0.01). Black and Hispanic patients presented with a worse baseline DR severity compared with White and non-Hispanic patients (odds ratio, 1.23 and 1.71, respectively; P < 0.01).


There are ethnic and insurance-based disparities in VA and disease severity upon initiation of anti-VEGF therapy for DME treatment. Public health initiatives could improve timely initiation of treatment.

Abbreviations and Acronyms:

DM (diabetes mellitus), DME (diabetic macular edema), DR (diabetic retinopathy), ETDRS (Early Treatment Diabetic Retinopathy Study), HbA1c (glycated hemoglobin), IRIS (Intelligent Research in Sight), NPDR (nonproliferative diabetic retinopathy), OR (odds ratio), PDR (proliferative diabetic retinopathy), VA (visual acuity), VEGF (vascular endothelial growth factor)

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