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Jordan Stone, Hideki Fukuoka, Robert N Weinreb, Natalie A Afshari; The Relationship between Insurance Coverage, Demographics, and BSCVA at the Time of Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1995.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the relationship between demographic variables, including race, age, and insurance coverage, and preoperative Best Spectacle-Corrected Visual Acuity (BSCVA) before the point of first-eye cataract surgery.
Using surgical logs from two cataract surgeons, we identified 1,108 subjects who underwent cataract surgery between Jan 2013 and Aug 2015 at the Shiley Eye Institute, University of California San Diego. Of those subjects, we reviewed 836 available patient charts and, based upon exclusion criteria (patients who received cataract surgery before the study period, outside Shiley, and patients undergoing one or more additional eye procedures concomitantly, were excluded), included 600 patients in the final analysis. We collected medical record data from the patient appointment immediately preceding cataract surgery, including BSCVA in each eye (converted to a logMAR score), insurance coverage (public, private, uninsured), race, gender, age, systemic and ocular co-morbidities, ocular surgical history, body mass index (BMI) and smoking status (in pack years). We used ANOVA to assess significant differences in mean preoperative BSCVA in the operated eye among groups. We used linear regression to assess relationships between smoking, BMI, and operated eye BSCVA. Significant variables in univariate analysis were included in a multivariate regression model, then reduced using a stepwise selection procedure.
In univariate analyses, there were significant overall differences in BSCVA between groups by insurance type (public, private, uninsured), race (Asian, Black, Hispanic, White, Other) and gender (Male, Female) (P<0.001, P<0.001, P=0.019, respectively). In multivariate analysis, significant pairwise differences were found, with better BSCVA associated with white race (0.848, logMAR [Snellen 20/140]) than Hispanic race (1.060, [20/230], P=0.017), and better BSCVA associated with private insurance (0.788, [20/125]) vs. public insurance (0.959, [20/180], P=.0002).
Hispanic race and public insurance coverage were both associated with worse pre-operative BSCVA compared with white race and private insurance, respectively, which suggests limited access to eye care services may predispose these groups to present with a greater degree of visual impairment than their counterparts. Further research is needed to parse the contribution of each factor to this disparity.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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