Geographic Distribution of Access to Diabetic Retinopathy Care in the United States: An American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) Analysis.

We identified 11,254,015 therapeutic and 35,892,574 diagnostic procedures from 1,142,505 patients with diabetic retinopathy.

Urban practices performed 95-99% of all procedures, 67-80% after adjusting for population differences, and 65-90% after adjusting for disease burden, with non-urban sites contributing only 1-35% across categories.

Non-urban residents had a higher PDR prevalence (18.21%vs16.02%) and higher rates of all therapeutic procedures.

Of those receiving care at urban practices, 47.7% had a >1-year optical coherence tomography gap versus 44.1% at non-urban practices; this increase in discontinuity was disproportionately larger among older, Black patients, and those with lower household incomes.