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Samantha L Williamson, Li Wang, Chasidy Singleton; Prevalence and Severity of Cataracts in an Underserved Population in Nashville, Tennessee. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1569.
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To estimate the prevalence of cataracts and presentation of legal blindness from cataracts in an urban, underserved population. Potential risk factors associated with advanced disease, including socioeconomic disparities, were also investigated.
Retrospective IRB-approved chart review of new patient encounters at Nashville General County Eye Clinic from 2006 through 2011. Data were analyzed by descriptive statistics. Of a total 4700 new patients, 1308 had cataracts (identified by ICD-9 codes 366.xx). Patients were stratified by age, gender, race, best-corrected vision, and level of treatment. The relationship between socioeconomic, medical, and environmental factors and the severity of vision loss was assessed.
The prevalence of cataracts over 5 years in this underserved population was 27.8%, which was statistically significant (p<0.001) compared to the documented U.S. prevalence of 17.2% among people over 40. Patients averaged 57 +/- 11 years of age (range 49 to 64 years). By race, 30.1% identified as Caucasian, 55.7% as African-American, 5.8% Hispanic, and 8.4% of other ethnicities. Females comprised 55.1% and males 44.9%. 35.5% of patients required surgery and 33% were treated with refractive correction. 44.9% were uninsured/self-pay, 23.6% on Medicare, 15.8% on Medicaid, 7.4% had commercial insurance, and 8.3% were incarcerated. Legal blindness in patients younger than 60 was seen in 13.1% of this population, 80% of whom required surgery. The most common medical conditions were hypertension (52%), diabetes (39%), hyperlipidemia (24%), and COPD (9.4%). This group had higher rates of incarceration (26.5%), lack of insurance (46.5%), prior ocular trauma (42%), and illicit drug use (21.8%).
Patients in this underserved population exhibit a higher prevalence of cataracts than the general US population. Younger patients with advanced disease tended to be uninsured or institutionalized, have multiple medical co-morbidities, and endorse a history of prior ocular trauma and drug use.
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