Racial disparities in patients with proliferative diabetic retinopathy treated with pars plana vitrectomy in an underserved population.

BACKGROUND

Proliferative diabetic retinopathy (PDR) is a serious microvascular complication of diabetes that can lead to irreversible vision loss. Prior research studies have documented how racial minorities with PDR experience less routine screening, less frequent treatment, and more complications. Although pars plana vitrectomy (PPV) is a widely used treatment modality for PDR, minimal research is currently available addressing how race impacts surgical presentation and outcomes.

METHODS

This study is a retrospective case series involving a sample of patients who underwent PPV for PDR at a county hospital between January 1, 2014, and December 30, 2019. Patients were included if they had a follow-up period of at least six months. The data collection included demographic data, medical history, surgical indications, operative outcomes, and complications. Snellen best corrected visual acuity (BCVA) was converted to logMAR for data analysis. Statistical analysis included chi-square testing, analysis of variance, generalized linear modeling, and multivariate analysis.

RESULTS

The study cohort consisted of 715 patients (915 eyes) receiving PPV for the treatment of PDR. In the patient cohort, 576 patients were Hispanic (80.6%), 103 patients were Black (14.4%), and 36 patients were Non-Hispanic White (5.0%). The majority of the patient cohort (75%) received charity insurance. Black patients had significantly higher pre-operative HbA1c levels than Hispanic patients (8.779 vs. 8.271, p = 0.011). Black patients were more likely to undergo surgery for a TRD than Hispanic patients (OR: 0.901, p < 0.001) and White patients (OR: 0.870, p < 0.001) and were more likely to have macula-involving TRDs compared to Hispanic patients (OR: 1.194, p < 0.001) and White patients (OR: 1.289, p = 0.005). Based on the multivariate analysis performed, race did not impact surgical outcomes, including post-operative visual acuity, anatomic success rate, and the need for a repeat surgery.

CONCLUSIONS

The main findings of this study indicate that Black patients are receiving surgery when they have more advanced diabetic retinopathy. However, there were no significant differences in surgical outcomes.