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New research · Ophthalmology
Ophthalmology · 1d
Paper of the Week
Cohort studyOphthalmology · 2026

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

Uday Pratap Singh Parmar, Asahi Fujita, Anagha Lokhande … IRIS® Registry Analytic Center Consortium
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OphthalmologyCohort study

Most non-urban residents with diabetic retinopathy receive care in urban practices.

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

Uday Pratap Singh Parmar et al. · Ophthalmology · 2026
Purpose

To evaluate access to diabetic retinopathy (DR) care by quantifying the geographic distribution of therapeutic and diagnostic procedures for DR across the United States.

Methods

Using the IRIS® Registry (Intelligent Research in Sight), we identified patients with ≥2 International Classification of Disease(ICD) codes for DR between January 1, 2013, and December 31, 2024.

Results
people living outside cities received treatments for diabetic retinopathy in city practices
More results

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

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.

More results

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 OCT 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.

“
Conclusion

DR-related diagnostic and therapeutic services were concentrated predominantly in urban practice locations, even after adjustment for population differences and disease burden, and support the need for strategies to improve access in non-urban communities.

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