Pre-Operative Demographic, Visual, Clinical, and Health Variables and Their Relationship With Cataract Surgery Wait Time in Montreal, Quebec

Abstract

Purpose: : To determine the demographic, visual, clinical, and health variables associated with longer wait times for cataract surgery in a country with publicly funded universal health care (Montreal, Quebec, Canada).

Methods: : Patients awaiting cataract surgery were recruited from Maisonneuve-Rosemont Hospital in Montreal, Quebec from 1999-2000 (n=509) and a second cohort from 2006-2007 (n=163). About two weeks before surgery, patients completed an interviewer-administered questionnaire. Date of entry onto the hospital waiting list and date of cataract surgery were recorded. Best-corrected visual acuity was measured in each eye using an ETDRS acuity chart and was converted to logMAR. The 5-item Cataract Symptom Scale (CSS5), SF-36, VF-14, and Geriatric Depression Scale (GDS) were given. Patients were asked about systemic and ocular comorbidities. Wilcoxon rank sum tests, chi-square tests, and logistic regression were used to determine those variables associated with wait times of 6 months or more compared to less than 6 months. Analyses were first done stratified by cohort and were combined if the odds ratios were similar in size and direction for each cohort.

Results: : The variables that were associated with a wait time of 6 months or greater in unadjusted analyses were physician (Chi square, p<0.001), more cataract symptoms (Wilcoxon, p=0.016), a greater number of systemic comorbidities (Wilcoxon, p<0.001), more depressive symptoms (Wilcoxon, p=0.009), and worse SF-36 physical functioning scores (Wilcoxon, p=0.013). Acuity in the surgical eye, VF-14 scores, glaucoma, age-related macular degeneration, age, sex, and education were not significantly associated with wait time. In a multiple logistic regression model, only physician and number of systemic comorbidities were statistically significantly associated with longer wait time with cataract symptoms, depressive symptoms, physical SF-36 score, and cohort also in the model.

Conclusions: : Patients who waited 6 months or more did not have significantly worse vision, cataract symptoms, or visual difficulty before surgery than those who waited less than 6 months. Certain physicians have much longer wait times than others. Strategies to monitor and reduce this disparity should be considered.

Keywords: cataract • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • visual acuity