A meta-analysis published March 19 in JAMA Ophthalmology assessed United States prevalence of age-related macular degeneration (AMD), diabetic retinopathy (DR), diabetic macular edema (DME), and retinal vein occlusion (RVO). The investigators included data from the National Health and Nutrition Examination Survey, Medicare fee-for-service claims, IBM MarketScan commercial insurance claims, and eligible population-based studies. The study also estimated disease burden of these 4 leading causes of vision impairment.

Prevalence and Population Estimates 

The study found that age-standardized prevalence of major retinal conditions in the United States per 100,000 people was 5,677 for AMD, 2,710 for DR, 317 for DME, and 214 for RVO, with higher rates in male patients and marked disparities across race and geography.  The analysis estimated that 21.9 million patients aged 40 years and older were living with AMD in 2022, corresponding to a crude prevalence of 13.6%. Approximately 10 million patients had DR, including 1.8 million with vision-threatening disease. DME affected 1.1 million patients, and RVO affected 0.9 million.  

Across conditions, prevalence was consistently higher in male vs female patients. For AMD, age-standardized prevalence was 6,104 per 100,000 in males vs 5,312 in females; for DR, 3,265 vs 2,211; for DME, 356 vs 281; and for RVO, 243 vs 191.  

Disparities by Race and Ethnicity 

Substantial differences were observed across racial and ethnic groups. AMD prevalence was 1.7 times higher in White vs Black patients. RVO prevalence was 2 times higher in White vs Hispanic patients. DR prevalence was more than 2 times higher in Black vs White patients and 1.8 times higher in Hispanic vs White patients. DME prevalence was 4.6 times higher in Black vs White patients and 3.7 times higher in Hispanic vs White patients.  

Geographic Variation 

State-level variation was pronounced. AMD ranged from 3,497 to 7,214 per 100,000 by state. DR ranged from 1,654 to 3,607, DME ranged from 126 to 504, and RVO ranged from 157 to 273. The study showed higher DR and DME prevalence concentrated in southern states, whereas AMD and RVO demonstrated different regional distributions.  

Access to Care and Costs 

Retina specialist availability varied widely, from 918 physicians in California to 3 in Wyoming. Patient-to-specialist ratios ranged from 30 to 6,345 depending on pathology and state, with the highest ratios observed in Wyoming for AMD, DR, and RVO, and in Mississippi for DME. Estimated annual payer costs were $13.41 billion for AMD, $6.23 billion for DR, $4.44 billion for DME, and $6.42 billion for RVO, with the highest total costs in California.  

Limitations and Conclusions

The authors noted that some data sources were more than 15 years old and may not reflect current demographic trends. Claims data may underrepresent uninsured populations, and extrapolation from older populations was required for some conditions. Modeling assumptions, including imputation of missing data and age-related trends, may introduce uncertainty. Additionally, prevalence estimates did not account for co-occurring retinal conditions and assumed all cases were treated in cost analyses.  

The authors concluded that “the estimated prevalence of these retinal conditions is substantial, highlighting a large health care burden,” emphasizing that disparities by race, ethnicity, and geography “may aid in future resource planning” and efforts to improve access and outcomes.  RP