Social Determinants of Health and Keratoconus Treatment
Keratoconus, a progressive eye disease resulting in corneal thinning and distortion, affects countless individuals worldwide. While medical advancements, including corneal cross-linking and transplantation, have significantly improved treatment outcomes, disparities based on social determinants of health (SDOH) are increasingly evident. Understanding the influence of these determinants can shed light on healthcare equity issues and inform practices to ensure all patients receive optimal care, regardless of their demographic or socioeconomic background.
Understanding Social Determinants of Health
Social determinants of health encompass a range of conditions in which individuals are born, live, learn, work, and age. These factors can include socioeconomic status, education, environmental conditions, healthcare access, and the influence of social networks. Relevant to keratoconus treatment, these determinants often dictate the level of care a patient receives, as evidenced by recent research presented by Zeba A. Syed, MD, at the American Academy of Ophthalmology meeting in October 2025.
Key Findings from Research
An analysis using data from the IRIS Registry, which tracked over 66,000 patients diagnosed with keratoconus from 2015 to 2020, revealed stark disparities in treatment options based on age, race, insurance status, and geographic location. Here are some salient points:
Demographic Influence:
- Younger patients were more likely to receive corneal cross-linking, a less invasive procedure aimed at halting disease progression. Conversely, older patients were more often referred for corneal transplantation, possibly due to a more rapid progression of the disease in younger individuals.
Gender Differences:
- A male predominance was noted, with men more likely than women to undergo both cross-linking and transplantation. This discrepancy may relate to a higher prevalence and severity of keratoconus among males.
Racial and Ethnic Disparities:
- The study highlighted significant racial disparities in treatment access. Black patients were less likely to receive cross-linking and more likely to require transplantation. In contrast, Hispanic or Latino patients exhibited a higher likelihood of receiving both procedures. Asian patients showed lower rates of treatment overall, regardless of the type.
Insurance Status:
- Insurance coverage played a crucial role in treatment accessibility. Patients reliance on Medicaid or Medicare were less frequently treated with cross-linking and more likely to undergo transplantation. This raises concerns about the adequacy of coverage for eye care procedures, especially concerning the riboflavin medication required for cross-linking.
- Geographical Variations:
- Patients residing in the West and Midwest exhibited higher rates of cross-linking treatment, while those in the South and Northeast were less likely to receive this intervention. These geographical discrepancies are potentially linked to variations in the availability of cornea specialists and regional public health policies affecting access to care.
The Impact of Social Determinants on Health Outcomes
The clear takeaway from this research is that social determinants of health substantially affect treatment pathways for individuals with keratoconus. Factors such as economic stability, education, and access to healthcare services can create barriers that impede timely and effective treatment, thereby exacerbating health inequities. For example, patients on public insurance may struggle to schedule timely eye appointments, affecting their condition’s progression and the necessity for more invasive treatments like transplantation.
Bridging the Gap
To mitigate these disparities, targeted interventions are needed:
Improving Access:
- Policymakers should prioritize equitable healthcare access for vulnerable populations, including expanding Medicaid coverage for procedures like corneal cross-linking and investing in community health initiatives to address gaps in care.
Increasing Awareness and Education:
- Raising awareness among healthcare providers about the implications of SDOH on treatment decisions can lead to more equitable care. Providers should receive training on the importance of understanding their patients’ socioeconomic contexts.
Community Outreach:
- Community programs can play a crucial role in improving eye care access, particularly for underserved populations. These programs can engage patients, provide education on keratoconus, and connect individuals with necessary resources.
Research and Policy Interventions:
- Ongoing research is essential to identify specific barriers that prevent equitable access to keratoconus treatments. Policies targeting these barriers can help establish more inclusive healthcare systems.
- Patient-Centered Care:
- Encouraging a patient-centered approach, where healthcare providers consider patients’ backgrounds, preferences, and circumstances, can enhance compliance and engagement, thereby leading to better health outcomes.
Conclusion
In summary, the treatment of keratoconus is significantly influenced by social determinants of health, highlighting the necessity of addressing these disparities through concerted efforts. As advancements in treatment continue to progress, ensuring equal access to these innovations remains paramount. By recognizing and acting upon the multifaceted factors that influence health outcomes, healthcare systems can work towards a future where all patients with keratoconus receive the effective, timely treatment they deserve, regardless of their social standing or background.
