{
  "abstract": "Purpose\n\nTreatment deviations in exudative age-related macular degeneration (exAMD) are common and lead to worse visual outcomes; reasons remain incompletely understood. We sought to identify distinct treatment patterns in newly diagnosed, treatment-naïve exAMD and to evaluate associations with social determinants of health (SDH) and baseline vision.Design\n\nMulticenter retrospective cohort study.Participants\n\nA total of 15 664 newly diagnosed, treatment-naïve exAMD patients receiving at least one intravitreal injection between January 1, 2014 and January 1, 2024 across 17 academic medical centers in the Sight Outcomes Research Collaborative ophthalmology big data repository.Methods\n\nTreatment patterns over the first 12 months were grouped using sequence clustering. Mixed-effects logistic regression evaluated associations between cluster membership and sex, age, race and ethnicity, primary language, urbanicity, primary insurance, distressed communities index, Charlson comorbidity index, and baseline logarithm of the minimum angle of resolution visual acuity.Main outcome measures\n\nSequence-derived treatment cluster membership and its association with SDH and baseline vision.Results\n\nTwo clusters were identified: \"frequent treatment\" (67.4%) and \"nonpersistent\" (32.6%); the latter characterized by a few initial injections followed by early treatment cessation. Nonpersistence was best differentiated by ≥ 7 months without an office visit or treatment (Youden index, 0.83; area under the curve, 0.93). In the adjusted model, factors associated with nonpersistent cluster membership included Black race (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.11-1.80), Hispanic ethnicity (aOR, 1.38; 95% CI, 1.00-1.90), older age at index date (aOR, 1.08 per decade; 95% CI, 1.03-1.13), rural residence (aOR, 1.32; 95% CI, 1.11-1.58), increasing distressed communities index (aOR, 1.03; 95% CI, 1.01-1.05), Medicaid insurance (aOR, 1.62; 95% CI, 1.03-2.52), worse baseline logarithm of the minimum angle of resolution acuity (aOR, 1.71 per unit; 95% CI, 1.54-1.91), and lower Charlson comorbidity index (aOR, 0.95 per point; 95% CI, 0.93-0.97).Conclusions\n\nDemographics, SDH, and vision were associated with nonpersistence in newly diagnosed exAMD. Social determinants of health‑informed identification of high-risk individuals may guide qualitative work on modifiable barriers and intervention development to prevent irreversible vision loss.Financial disclosures\n\nProprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.",
    "Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois.",
    "Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan.",
    "Department of Ophthalmology and Visual Sciences, University of Alabama Birmingham, Birmingham, Alabama.",
    "Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Timothy M Janetos"
    },
    {
      "affs": [
        1
      ],
      "name": "Adovich S Rivera"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Yang Li"
    },
    {
      "affs": [
        2
      ],
      "name": "Chris A Andrews",
      "orcid": "0000-0001-5130-6374"
    },
    {
      "affs": [
        0
      ],
      "name": "Paul J Bryar"
    },
    {
      "affs": [
        0
      ],
      "name": "Manjot K Gill",
      "orcid": "0000-0002-6933-9331"
    },
    {
      "affs": [
        0
      ],
      "name": "Jeremy A Lavine"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Joshua D Stein"
    },
    {
      "affs": [
        0,
        1,
        4
      ],
      "name": "Dustin D French"
    },
    {
      "name": "SOURCE Consortium∗"
    },
    {
      "name": "SOURCE Consortium"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/56f4s62aks047.bib",
  "cited_by": 0,
  "doi": "10.1016/j.xops.2026.101409",
  "fulltext_url": "https://europepmc.org/articles/PMC13683419",
  "id": "56f4s62aks047",
  "issns": [
    "2666-9145"
  ],
  "landing_url": "https://europepmc.org/article/MED/42908726",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2731|Retinal Diseases and Treatments"
    ]
  ],
  "openalex": "W7212147516",
  "pdf_url": "https://europepmc.org/articles/PMC13683419?pdf=render",
  "pmcid": "PMC13683419",
  "pmid": "42908726",
  "published": "2026-09-10",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/56f4s62aks047.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42908726",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42908726"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2731|Retinal Diseases and Treatments",
      "subfield": "general"
    }
  ],
  "title": "Social Determinants of Health, Vision, and Treatment in Exudative Age-Related Macular Degeneration.",
  "title_text": "Social Determinants of Health, Vision, and Treatment in Exudative Age-Related Macular Degeneration.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/56f4s62aks047",
  "venue": "Ophthalmology science",
  "versions": []
}