Almost 20 million Americans over 40 live with age-related macular degeneration (AMD). But it affects different populations, sexes, and races at different rates. Research shows there are also disparities in AMD care: who gets a diagnosis and receives treatment, and who’s included in clinical trials.
Women and Eye Health
Women are at a higher risk than men for getting AMD. This is in part because women have a longer life expectancy. On average, they live 5 years longer than men. AMD risk increases as you get older. But studies suggest more than age affects your risk.
Women also tend to have more severe AMD, with greater vision loss. Women also tend to get AMD at an earlier age. Research shows that even though AMD care has improved greatly in the last several decades, the imbalance in disease burden for women hasn’t.
Socioeconomic Status and AMD
Your socioeconomic status is a combination of factors such as your income, amount and kind of education, occupation, and where you live. A large study showed that lower socioeconomic status tends to go along with more vision problems and higher rates of eye disease.
Other studies show that fewer years of education are associated with higher rates of AMD. Less education is related to lack of awareness about health care. This leads to fewer eye checks and lower chances of sticking with treatment plans.
Race and AMD
According to the CDC, in the U.S. about 1.2 million Black people and 2.1 million Hispanic people have AMD. The number of white people with AMD tops 15 million.
If you’re white, you have a higher chance of having medium to large-sized drusen in your eyes. Drusen are yellow deposits under the retina. They don’t cause AMD, but having them increases your risk of getting AMD.
When compared to Black adults, white adults are more likely to have advanced AMD. Studies suggest this is because white adults are three times more likely to have hyperpigmentation, a darkened spot in the eye linked to advancement of the disease.
One theory as to why white people get AMD at such a higher rate holds that cells in the retinas of Blacks people have more melanin. This melanin may protect against UV light and pigment changes that can lead to drusen formation and AMD.
But even with lower rates of AMD, Black people are less likely to receive treatment when they have it. In studies of Medicare recipients 65 and older, Black, Hispanic, and Asian-American people were up to 74% less likely to have a diagnosis of AMD, but up to 86% less likely to get anti-VEGF injection treatment.
Representation in Clinical Trials
Stats show that Black and Hispanic adults are underrepresented in clinical trials for ophthalmology drug approvals. A study found that those trials don’t include numbers from ethnic and racial groups in the same percentages that they exist in the U.S. population.
For example, at least 4% of the people in the U.S. with AMD are Black, but for the last 20 years Black people have made up only 0.177% of trial participants.
In addition to structural and institutional racism, some of the potential reasons for these skewed numbers include financial resources, transportation, employment, low trust in the health care system, and lower health literacy.
The National Eye Institute has plans to address this disparity. They’re currently working on initiatives to recruit clinical trial subjects that represent the U.S. population more accurately. They’re combining efforts with the National Institute of Minority Health and Health Disparities to include experts in both eye care and health disparities.
The American Academy of Ophthalmology is also launching programs to increase diversity in ophthalmology care. The Minority Ophthalmology Mentoring (MOM) encourages medical students from minority populations to specialize in ophthalmology. The hope is that increasing the number of doctors of color would improve access to eye care in underserved communities.
