Severity of dry eye, treatment varies among ethnic minority patients
Patients who belong to racial and ethnic minority groups clinically exhibit worse objective measures of dry eye than patients who do not belong to these groups, according to poster research presented at the annual meeting of the Association for Research in Vision and Ophthalmology.
“Dry eye is a very common condition and very expensive to treat,” said David Cui, a medical student at Penn State College of Medicine in Hershey, Pa., One of the study researchers and research assistant at Johns Hopkins University School. of Medicine in Baltimore, Maryland.
Cui noted that estimates of the global prevalence of dry eye range from 5 to 50 percent, and that the disease is a leading cause of patient visits to an ophthalmologist. In the United States, the estimated cost associated with treating dry eye is $ 3.8 billion per year, which places significant strain on the nation’s health care system, Cui said.
Cui noted the need to examine the topic of race, whether it influences access to dry eye care and whether patients have greater severity of dry eye, noting that there is no published literature. on disparities regarding race, ethnicity and dry eye patients. He added that the existing literature on dry eye and racial minority groups is limited to patients in Asia and research shows that these patients have a higher prevalence with potentially increased severity.
The retrospective investigation involved reviewing the electronic health records of patients who were treated in a single center by a single ophthalmologist, Esen Karamursel Akpek, MD, Bendann family professor of ophthalmology and founder of the Ocular Surface Disease Clinic at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, Cui noted. The researchers excluded patients whose dry eye was secondary to another ocular surface disease such as mucosal pemphigoid, Stevens-Johnson syndrome, atopic keratoconjunctivitis, or graft-versus-host disease. Cui and his fellow researchers divided the patients into four categories: Asian, Black, Hispanic or Latino, and White.
A total of 465 patients were included: 157 were white, 157 were black, 85 were Asian, and 66 were Hispanic or Latino. Most of the patients (78%) were female and the sex of the patients was equivalent in all cohorts. They used objective measures of dry eye such as conjunctival staining, corneal staining, combined ocular surface staining, Schirmer’s test, and tear osmolarity at baseline and at a final visit. Investigators found that more minority patients did not have health insurance or were on Medicaid, and that black and Hispanic patients had lower estimated median family incomes than white patients. Another finding that has emerged is that fewer minority patients have ever received prescription treatments or procedures. At their baseline visit, patients from minority groups had poorer mean conjunctival and corneal staining scores.
There was, however, no statistically significant difference noted in the objective measures of dry eye at the final visit for patients with a minimum of 18 months of follow-up. Cui drew an analogy between the treatment of dry eye, often a chronic disease in which the main symptom is eye discomfort, and the evidence on the treatment of chronic pain.
“There are a lot of publications in the [United States] which show that providers treat people with chronic pain differently based on their race and ethnicity, ”he said. “Patients who are not white will generally be prescribed less treatment for their pain. Additionally, Cui pointed out that clinicians are less likely to sympathize with non-white patients or validate their pain and suffering.
Because dry eye is not a disease that can lead to permanent vision loss if left untreated, clinicians can systematically contract out the disease although it has a negative impact on quality of life, Cui explained. Cui and his fellow researchers found that fewer minority patients had received prescription treatments or procedures (white patients, 61.8%, vs. minority patients, 30.6% to 43.9%, all P .016).
“Medicaid patients often have low incomes, which makes it difficult to access care, and these insurance policies almost never cover dry eye treatments,” he said. Cui noted that the study is limited by the fact that it is retrospective and was conducted in a single center.
“Because of that, it’s difficult to establish a causal link,” he said. “We can correlate. We see that [minority patients] have barriers to care, such as lower family income, are more likely to be uninsured or to receive Medicaid and have lower full-time jobs.
Cui said investigators are also finding that members of these groups receive less care and have worse objective dry eye parameters, but the differences disappear after proper treatment and follow-up.
Cui thanked his mentors for their guidance and noted that this study will serve as a basis for their team for future studies regarding the disparities associated with the diagnosis and management of dry eye disease.
Cui has not reported any financial disclosures related to this content.