Racial/ethnic differences in rates of penetrating or endothelial keratoplasty for fuchs endothelial corneal dystrophy among US medicare beneficiaries

Importance: Fuchs endothelial corneal dystrophy (FECD) is the most common indication for corneal transplant in the United States. The association between race/ethnicity and incidence of advanced FECD, defined by a need for endothelial or penetrating keratoplasty, has not been investigated. Observations: The 2014 US Medicare Limited Data Set (5%sample of 27 163 740 fee-for-service Medicare patients) was analyzed for rate of keratoplasty performed for FECD (International Classification of Diseases, Ninth Edition code 371.57), stratified by race/ethnicity. Among all Medicare beneficiaries 65 years or older, a diagnosis code for FECD was used in 1.55%(95%CI, 1.51%-1.59%) of white and 1.38%(95%CI, 1.26%-1.50%) of African American beneficiaries who had an ophthalmologist eye examination in 2014 (P = .01). Among beneficiaries who obtained medical care for FECD, keratoplasty was 1.9 times more likely in white than African American patients (4.7%; 95%CI, 4.2%-5.2%vs 2.5%; 95%CI, 1.1%-3.9%; P < .001) among approximately 6500 patients undergoing 8420 procedures. Conclusions and Relevance: In 2014, keratoplasty was 1.9 times more likely in US Medicare fee-for-service white patients than African American patients with FECD. This might be caused by racial/ethnic differences in the biology of FECD, access to care, or other unidentified factors.