Maria Berrocal: Hello, and welcome to Clinical Minute. I'm your host, Maria Berrocal. Each episode highlights research that can refine how we care for our patients. Today, I'm joined by Dr. Yoshihiro Yonekawa, corresponding author on a recent paper examining geographic and socioeconomic disparities in ROP. Dr. Yonekawa, thank you so much for joining me.

Yoshihiro Yonekawa: Dr. Berrocal, thanks so much for having me. It's a pleasure.

Maria Berrocal: Yes, this is a very important topic. So can you please summarize your findings in the paper?

Yoshihiro Yonekawa: Sure thing. So first of all, I just want to give a lot of credit to our fellow at the time who spearheaded this project. Her name is Rebecca Soares, who should be the one sitting here. She's not at the meeting this year, but she put amazing work into this.

And so, in ROP care, we've been talking about difficulties with access to care, access to ROP treatment in the United States. We've been talking about this for decades, and we know that there's a problem, but there was never objective data showing this. Before this, it was a PAT survey from, like, 15 or 20 years ago now, showing that fewer people are interested in doing ROP care. But other than that, there's nothing.

And so what we did was use a data set that was available of NICUs and whether they do ROP treatment or not. We mapped it out throughout the country, and we measured driving times and distances from census tracts to these ROP care treatment centers.

We found a couple of findings. One, as expected, there was less access to care if you lived in a rural area compared to urban or suburban areas. Areas with higher rates of poverty, less education, and non-white populations were at the highest risk for decreased access to care.

Maria Berrocal: Okay. And how do you think policy can be changed to address this significant problem?

Yoshihiro Yonekawa: Yeah. So we do studies because we want to improve care, right? But I think the first thing to do is to show that there's a problem, because before now, we didn't have data to bring to policymakers to show that there's a problem.

And so I think this is kind of the first step in identifying the problem that there are disparities in access. And we did show that poverty had, I think, one of the highest odds ratios.

And for that, the reason we think is: If you're in poverty, you have less prenatal care. If you have less prenatal care, you have more premature births. More premature births, you get ROP.

And so I think that's where resources can be shifted. It really makes us double down on the importance of prenatal care. That's one.

Maria Berrocal: And did you see any disparities in different regions in the United States?

Yoshihiro Yonekawa: Yeah, great point. So the U.S. is so big, and living in the Northeast, everything is clustered together. So, as you can imagine, living in the Northeast, you had very few access-to-care issues. If you lived in the West or the South, you were at higher risk for decreased care.

Maria Berrocal: Okay. So those are the areas where maybe governments, you know, and state governments can put more effort into this.

So how do you think technology could be used to address these disparities?

Yoshihiro Yonekawa: Yeah, you know, we talk about technology and ROP a lot, but the vast majority of the conversation is in screening.

So we have telemedicine, which has been game changing for access to screening for ROP, but the cameras can't do injections. The cameras can't do lasers. You know, it'll be the day when the machines take over, basically. But until the cameras can do that, we still need physicians to provide the care.

And in rural America, there are fewer NICUs, but also fewer treaters. And so I think that's an area that we need to work on.

But with the advent of anti-VEGF agents, I think that has probably increased the workforce because it's easier to do injections than lasers. So more people are able to provide that care.

So I think that's been another element that we don't talk enough about that's been kind of game changing in terms of access.