Predictors of Receiving Keratoplasty for Fuchs’ Endothelial Corneal Dystrophy among Medicare Beneficiaries

Purpose: To identify factors associated with receipt of endothelial keratoplasty (EK) and penetrating keratoplasty (PK) in patients with Fuchs’ endothelial corneal dystrophy (FECD). Design: Retrospective cohort study. Participants: Medicare beneficiaries 65 years of age or older with a FECD diagnosis between 2011 and 2019. Methods: The 100% Medicare fee-for-service administrative claims database was queried for treatment-naïve FECD patients. A multivariate logistic regression model including age, race and ethnicity, sex, geography, ocular comorbidities and surgeries, Charlson comorbidity index (CCI), and socioeconomic status was used to identify factors associated with receipt of EK and PK. Kaplan-Meier survival analyses were used to determine the rate of EK after cataract or complex or other anterior segment surgery. Main Outcome Measures: Factors associated with receipt of an EK or PK, plus rate of EK after cataract or complex or other anterior segment surgery. Results: Of 719 066 beneficiaries identified, 31 372 (4.4%) received an EK and 2426 (0.3%) received a PK. In a multivariate analysis, female sex decreased likelihood of both EK and PK (adjusted odds ratio 0.83 [95% confidence interval 0.81–0.85] and 0.84 [0.78–0.92], respectively), while Western residence (1.33 [1.29–1.38]; 1.25 [1.11–1.42]) compared to Southern and history of complex or other anterior segment surgery (1.62 [1.54–1.70]; 5.52 [4.97–6.12]) increased the likelihood of both. Compared to Whites, the likelihood of EK was decreased for Black (0.76 [0.72–0.80]), Asian or Pacific Islander (0.54 [0.48–0.61]), and Hispanic or Latino (0.62 [0.55–0.70]) race and ethnicity, while for the same groups likelihood of PK was increased (for Black 1.32 [1.14–1.53]; Asian/Pacific Islander 1.46 [1.13–1.89]; and Hispanic/Latino 1.62 [1.25–2.11]). Following cataract or complex/other anterior segment surgery, rates of EK were 1.3% and 3.3% at 1 year and 2.3% and 5.6% at 8 years, respectively. Conclusions: In a multivariate analysis, women beneficiaries are less likely to receive EK or PK for FECD compared with men, whereas non-White beneficiaries are less likely to receive EK and more likely to receive PK compared with White beneficiaries.