Social Determinants of Health, Vision, and Treatment in Exudative Age-Related Macular Degeneration.

Purpose: Treatment deviations in exudative age-related macular degeneration (exAMD) are common and lead to worse visual outcomes; reasons remain incompletely understood. We sought to identify distinct treatment patterns in newly diagnosed, treatment-naïve exAMD and to evaluate associations with social determinants of health (SDH) and baseline vision. Design: Multicenter retrospective cohort study. Participants: A total of 15 664 newly diagnosed, treatment-naïve exAMD patients receiving at least one intravitreal injection between January 1, 2014 and January 1, 2024 across 17 academic medical centers in the Sight Outcomes Research Collaborative ophthalmology big data repository. Methods: Treatment patterns over the first 12 months were grouped using sequence clustering. Mixed-effects logistic regression evaluated associations between cluster membership and sex, age, race and ethnicity, primary language, urbanicity, primary insurance, distressed communities index, Charlson comorbidity index, and baseline logarithm of the minimum angle of resolution visual acuity. Main Outcome Measures: Sequence-derived treatment cluster membership and its association with SDH and baseline vision. Results: Two clusters were identified: "frequent treatment" (67.4%) and "nonpersistent" (32.6%); the latter characterized by a few initial injections followed by early treatment cessation. Nonpersistence was best differentiated by ≥ 7 months without an office visit or treatment (Youden index, 0.83; area under the curve, 0.93). In the adjusted model, factors associated with nonpersistent cluster membership included Black race (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.11-1.80), Hispanic ethnicity (aOR, 1.38; 95% CI, 1.00-1.90), older age at index date (aOR, 1.08 per decade; 95% CI, 1.03-1.13), rural residence (aOR, 1.32; 95% CI, 1.11-1.58), increasing distressed communities index (aOR, 1.03; 95% CI, 1.01-1.05), Medicaid insurance (aOR, 1.62; 95% CI, 1.03-2.52), worse baseline logarithm of the minimum angle of resolution acuity (aOR, 1.71 per unit; 95% CI, 1.54-1.91), and lower Charlson comorbidity index (aOR, 0.95 per point; 95% CI, 0.93-0.97). Conclusions: Demographics, SDH, and vision were associated with nonpersistence in newly diagnosed exAMD. Social determinants of health‑informed identification of high-risk individuals may guide qualitative work on modifiable barriers and intervention development to prevent irreversible vision loss. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.