Combined Cataract Surgery and Kahook Dual Blade Goniotomy in Patients with Limited English Proficiency

Abstract

Purpose : Few studies have examined the effects of language barriers in ophthalmology. This retrospective observational study explores differences in outcomes between limited English proficiency (LEP) patients and English proficient (EP) patients undergoing combined cataract surgery and Kahook Dual Blade (KDB) goniotomy.

Methods : Patients who underwent cataract surgery between 2014 and 2019 in the University of Colorado Cataract Surgery Outcomes Database were analyzed. We defined LEP as need or preference for an interpreter during medical encounters. Demographic and pre-operative characteristics analyzed included gender, race/ethnicity, intraocular pressure (IOP), logMAR best corrected visual acuity (BCVA), presence of mature cataract, and type of glaucoma. The main outcomes of this study included the complexity of surgery, intraoperative complications, change in BCVA, post-operative IOP, and number of IOP-lowering medications. Comparisons between groups were made using logistic regression analysis with general estimating equations to account for some patients having two eyes included in the study.

Results : A total of 43 LEP and 666 EP patients who underwent combined cataract surgery and KDB goniotomy were analyzed. LEP patients had a significantly higher rate of mature cataracts (4.6%) and complex surgery (46.5%) compared to EP patients (0.3% and 13.8%, respectively; p < 0.01 for both). Post-operative change in BCVA was significantly greater in LEP patients compared to EP patients (mean improvement of 0.260 versus 0.157, p = 0.01). No differences were observed between groups for pre- or post-operative IOP, number of IOP-lowering medications, or intraoperative complications.

Conclusions : This study highlights healthcare disparities associated with language barriers and suggests delayed access to specialty eye care. Encouragingly, it confirms the benefit of combined cataract surgery and KDB goniotomy in the LEP population. These findings demonstrate the need for outreach to LEP patients to ensure regular ophthalmologic care.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.