Conclusions: In 2019 California Medicare beneficiaries with retinal ischemia, poor socioeconomic status was associated with increased prevalence of neovascular glaucoma before adjustment for demographic factors. Investigation is needed of demographic differences in management of retinal ischemia.

Objective: To examine associations between poor socioeconomic status (SES) and prevalence of neovascular glaucoma (NVG) in at-risk individuals in the California (CA) Medicare population.

Methods: The study included 2019 CA Medicare beneficiaries with retinal ischemia (i.e. proliferative diabetic retinopathy, retinal vein occlusion, and/or ocular ischemic syndrome). Exposures were Centers for Disease Control and Prevention Social Vulnerability Index socioeconomic status theme (SVI-SES) quartile and dual Medicare/Medicaid eligibility (DMME), and the outcome was NVG diagnosis. Covariates included age, sex, race and ethnicity, and Charlson Comorbidity Index (CCI) score. Logistic regression modeling was used to examine associations between SVI-SES, DMME, and NVG, adjusting for demographics only, CCI only, and all covariates, overall and stratified by race and ethnicity.

Results: There were 41,972 beneficiaries with retinal ischemia, of whom 1,842 (4.4%) had NVG. Presence of DMME was associated with increased prevalence of NVG in unadjusted and CCI-adjusted models (unadjusted OR=1.23, 95% CI=1.12, 1.35; CCI-adjusted OR=1.18, 95% CI=1.07, 1.30), but not in demographic-adjusted or fully adjusted models. In stratified analyses, fourth versus first SVI-SES quartile was associated with increased prevalence of NVG for beneficiaries of Non-Hispanic White and Other race and ethnicity (adjusted OR=1.39, 95% CI=1.10, 1.70 for Non-Hispanic White; adjusted OR=2.17, 95% CI=1.08, 4.33 for Other).

Conclusions: In the 2019 CA Medicare population, associations between high SVI-SES, DMME, and increased prevalence of NVG were weakened after adjustment for demographic factors. Further studies are needed to assess for differential management of retinal ischemia in at-risk individuals based on age, sex, and race and ethnicity, independent of SES.