Retinal Conditions Present Significant Health Care Burden in US

The prevalence of retinal conditions throughout the US presents a significant health care burden nationwide, according to a study published in JAMA Opthalmology.¹ The prevalence of each retinal condition varied, and identifying the areas of disparities could help to indicate where resources need to be allocated to properly address the incidences.

Age-related macular degeneration (AMD), diabetic macular edema (DME), diabetic retinopathy (DR), and retinal vein occlusion (RVO) are among the most common retinal conditions that affect those with vision impairment, noted as the leading causes of blindness in adults.² These conditions can affect patients on a socioeconomic level, especially if they become less productive and if they need consistent care over time. Resulting disparities could present obstacles to treating and preventing these conditions. This meta-analysis aimed to estimate the prevalence of AMD, DR, DME, and RVO as of 2022 in the US, with analyses of prevalence based on race and ethnicity, sex, and residence of the patients.

The study investigators used Medicare Part B fee-for-service claims, the National Health and Nutrition Examination Survey (NHANES), and the CDC’s Vision and Eye Health Surveillance System (VEHSS) to conduct the meta-analysis. VEHSS was used to obtain definitions for all of the conditions. AMD was reported in adults 40 years and older, RVO was reported in adults 18 years and older, and DME and DR were estimated as a proportion of patients with diabetes of all ages.

There were approximately 21.9 million (95% uncertainty interval [UI], 17.9-26.8 million) patients in the US who were living with AMD in the US in 2022. This totaled a crude prevalence of 13.6% (95% UI, 11.1%-16.6%). Men were more likely to have AMD compared with women (6104 vs 5312 per 100,000, respectively) and prevalence was higher in White individuals compared with Black individuals (6038 vs 3534 per 100,000, respectively). Rhode Island was among the areas with the highest prevalence at 7214 per 100,000 people.

There were approximately 10.0 million people (95% UI, 8.4-12.0 million) who were estimated to be living with DR in the US, equaling a crude prevalence of 3.0% (95% UI, 2.3%-4.3%). DR was more prevalent in men than women (3265 vs 2211 per 100,000) and Black individuals compared with White (4462 vs 2148 per 100,000, respectively); those who identified as Hispanic also had a high prevalence (3830 per 100,000). Mississippi was among the areas with the highest prevalence at 3607 per 100,000 people.

An estimated 1.1 million (95% UI, 0.8-1.5 million) people were living with DME in the US in 2022, equaling a crude prevalence of 0.3% (95% UI, 0.3%-0.5%). Prevalence was slightly higher in men (356 vs 281 per 100,000) and slightly higher in Black individuals compared with Hispanic individuals (712 vs 578 per 100,000); White individuals had a lower prevalence than either (155 per 100,000).

RVO had the lowest number of patients living with the condition, at 0.9 million (95% UI, 0.5-1.3 milliom), which indicated a crude prevalence of 0.3% (95% UI, 0.2%-0.4%). The prevalence was slightly higher in men (243 vs 191 per 100,000) and higher in White individuals compared with Hispanic individuals (243 vs 122 per 100,000, respectively). Rhode Island was among the highest in RVO prevalence at 273 per 100,000.

Access to treatment varied by state, as California had the highest number of retina specialists at 918 doctors whereas Wyoming had only 3 retina specialists in the state. Patient to retina specialist ratios were lowest in Washington, District of Columbia, for AMD (257) and RVO (30) and highest in Wyoming for AMD (6345) and RVO (357). Wyoming also had the highest patient to specialist ratio for DR at 3015, and Mississippi had the highest patient to specialist ratio for DME at 322. National annual payer costs were estimated at $13.41 billion for AMD, $6.23 billion for DR, $4.44 billion for DME, and $6.42 billion for RVO.

There were some limitations to this study. Out-of-date demographic trends were possible due to some data being more than 15 years old. Participants 40 years and older and in the NHANES database had missing disease status information imputed. Race and ethnicity could not be calculated for RVO or DME in those who were not White or Black but were non-Hispanic. The analysis assumed that RVO prevalence increased with age. Access to ophthalmologists could have influenced the prevalence at the county level. Sampling bias is possible among the insured population. True disease prevalence may be underestimated as institutionalized patients were not included in the calculations. Early- and late-stage disease were not stratified in AMD prevalence estimates. Co-occurrence of retina conditions was not accounted for in specialist access and payer cost analyses.

Overall, the authors wrote that the prevalence of retina diseases was high in the US, linked with the population of the US aging and diabetes rates also rising.³ “The racial, ethnic, and regional disparities highlighted in this study can aid future planning of US health care resources, providing guidance for the most at-risk communities and regions that would benefit from screening initiatives and/or early interventions,” the authors concluded.¹

References

1. Alvin TY, Ko S, Rosettie KL, et al. Prevalence and health care disparities of retinal conditions: a meta-analysis. JAMA Ophthalmol. Published online March 19, 2026. doi:10.1001/jamaophthalmol.2026.0319
2. About common eye disorders and diseases. CDC. May 15, 2024. Accessed March 23, 2026. https://www.cdc.gov/vision-health/about-eye-disorders/index.html
3. Urgent action needed as global diabetes cases increase four-fold over past decades. News release. World Health Organization. November 13, 2024. Accessed March 23, 2026. https://www.who.int/news/item/13-11-2024-urgent-action-needed-as-global-diabetes-cases-increase-four-fold-over-past-decades