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Carly Seidman, Abraham Sleem, Ann Ostrovsky; Impact of the Affordable Health Care Act on Demographics and Visual Acuities of Patients Presenting For Cataract Extraction in an Underserved Urban Population.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2138.
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© ARVO (1962-2015); The Authors (2016-present)
Insurance coverage under the Affordable Health Care Act (AHCA) took effect January 1st, 2014. We herein examined the impact of the AHCA on demographic characteristics and vision at presentation for cataract surgery in an underserved inner city population. Vision at presentation is utilized as a marker for access to ophthalmic care, assuming that patients with better access to care will seek care earlier.
A retrospective chart review was performed for all patients who presented for cataract surgery at a city hospital in Brooklyn, New York between July 2012 and October 2014. Gender, self-described ethnicity, age, and best-corrected visual acuity (BCVA in LogMar) at presentation for cataract surgery evaluation were extracted. All variables studied before (pre-AHCA) and after (post-AHCA) January 1, 2014 were compared with T-test and Chi Square-Test.
375 patients were included. There were 275 patients in the pre-AHCA group and 100 in the post-AHCA group. In both groups, there was a higher percentage of females to males (58.5% females vs 41.5% males pre-AHCA (p=0.02); and 67% females vs 33% males (p=0.01) post-AHCA). No significant changes in distribution of the sexes was found post-AHCA as compared to pre-AHCA (p=0.31). Average age was 66.6±10.7 years pre-AHCA and 66.1±9.4 years post-AHCA (p=0.76). The ethnic makeup of the two groups was similar and the most populous ethnic groups pre- vs post- AHCA were Hispanic 51.2% vs 49% (p=0.84), Caucasian 8.8% vs 14% (p=0.18), and African 27.4% vs 26% (p=0.84). Subgroup analyses revealed a significant increase in male African patients post-AHCA (p=0.01). BCVA at presentation was 1.04±0.9 pre-AHCA and 1.19±0.9 post-AHCA (p=0.15).
In the few months since its implementation, the AHCA has not brought about any appreciable changes in demographics of patients presenting for eye care in an inner city population. The average presenting BCVA in our population was rather poor, suggesting that patients wait until a significant level of blindness to present for surgery. The AHCA has not impacted presenting acuities and so suggests that patients at this point are not seeking eye care at earlier stages of their disease. More prospective data is needed to determine the impact of the AHCA on access to eyecare.
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