Association Between the Social Deprivation Index and Neovascular Age-Related Macular Degeneration Outcomes

Purpose: To evaluate whether disease severity at diagnosis and treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) may be stratified by the Social Deprivation Index (SDI; a measure of socioeconomic status [SES] where higher scores indicate greater socioeconomic deprivation). Methods: We conducted a retrospective cohort study of 643 adults with newly diagnosed unilateral nAMD who were treated with antivascular endothelial growth factor (anti-VEGF) therapy at the Retina Group of Washington. Data collected included best-corrected visual acuity (BCVA) at baseline and 12 months, presence of submacular hemorrhage, and injection frequency in the first year of treatment. Logistic regression was used to assess associations between SDI and BCVA outcomes. Results: A higher SDI score was associated with lower odds of achieving a BCVA of ≥20/40 at 12 months (odds ratio, 0.69, 95% CI, 0.48-0.98; P = .039). Submacular hemorrhage and non-White race were predictive of poorer outcomes, whereas sex at birth was not predictive. The number of anti-VEGF injections received over 12 months was similar between the high SDI quantile group and low SDI quantile group (mean 9.1 vs 8.8; P = .053). Age, baseline BCVA ≥20/40, and race were significant predictors of achieving a BCVA ≥20/40 at 12 months. BCVA at baseline was not significantly different between the SDI quantile groups, suggesting that disparities emerge during treatment rather than at diagnosis. Conclusions: The SDI is a useful metric of social determinants of health in patients with nAMD. Higher SDI was associated with poorer visual outcomes despite similar baseline vision and treatment exposure, suggesting that disparities extend beyond diagnosis to treatment effectiveness. These findings underscore the multifactorial nature of socioeconomic influences, including race, treatment adherence, and access, and the need for targeted strategies to improve equitable care.