title: Racial/Ethnic Differences in Rates of Penetrating or Endothelial Keratoplasty for Fuchs Endothelial Corneal Dystrophy Among US Medicare Beneficiaries.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mahr
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Keith H
authors.initials: KH
authors.lastname: Baratz
authors.affiliation: Health Sciences Research, Mayo Clinic, Jacksonville, Florida.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jay C
authors.initials: JC
authors.lastname: Erie
mesh_terms: D000368:Aged; D005006:Ethnicity; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000191:economics / Q000208:ethnology / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000191:economics*; D044469:Racial Groups; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology