# Elevated prevalence of age-related macular degeneration in a low-income urban primary care setting

## TL;DR

This study found a high rate of undiagnosed age-related macular degeneration in a low-income urban primary care population, highlighting health disparities and the need for better screening.

## Contribution

The study reveals a novel association between lower income and higher AMD prevalence in an urban primary care setting.

## Key findings

- Referable AMD prevalence was 48.4%, much higher than national estimates.
- Only 4 out of 151 AMD cases had been previously diagnosed.
- Lower median household income was significantly associated with higher AMD prevalence.

## Abstract

Age-related macular degeneration (AMD) is the leading cause of vision loss among adults over 50. Early detection enables interventions such as Age-Related Eye Disease Study (AREDS) supplementation to slow disease progression, yet AMD remains underdiagnosed in primary care, particularly in underserved populations. This study assessed AMD sample prevalence and its association with social determinants of health in a diverse, urban primary care cohort.

We performed a post hoc analysis of a cross-sectional study conducted from June 2020 to May 2023 at a hospital-based primary care clinic in New York City (NYC). Patients aged 50–89 underwent nonmydriatic color fundus photography graded independently by two physicians using Beckman Initiative criteria. Median household income by ZIP code served as a proxy for socioeconomic position. Multivariable logistic regression examined associations between AMD and demographic or social determinants of health variables.

Of 393 patients enrolled, 312 were included in the final analysis. Referable AMD was present in 48.4% of participants based on the Beckman classification, representing the sample prevalence within this clinic cohort and exceeding national population-based estimates. Only 4 of 151 AMD cases had been previously diagnosed. Referable AMD prevalence was higher in males than females (56.2% vs. 44.4%) and increased with age. Median household income was significantly lower among patients with referable AMD compared with those without ($72,000 vs. $151,000; p < 0.0001). In adjusted models, male sex (OR = 2.00, 95% CI 1.02–4.00) and lower income were strongly associated with referable AMD prevalence; race and age were not.

Undiagnosed referable AMD was highly prevalent within this primary care clinic sample of low-income, urban patients. Integrating affordable retinal screening, potentially aided by artificial intelligence, into primary care may help address vision health disparities driven by social determinants of health.

The online version contains supplementary material available at 10.1186/s12982-026-01672-0.