Nasolacrimal Duct Obstruction Care Differences Between Demographic Groups

Abstract

Purpose : Nasolacrimal duct obstruction (NLDO) is a common disorder reported to occur in 5-20% of newborns. Although disparities in healthcare due to racial and socioeconomic determinants have been reported in the pediatric population, there are few studies assessing differences between demographic variables in this condition. Thus, we studied the differences in NLDO care between racial and socioeconomic groups as a possible marker representing pediatric ophthalmic care equity between groups in the Washington DC metropolitan area.

Methods : After IRB approval, we reviewed data on children with NLDO at our institution from 2012 to 2022. Demographics (e.g. race, gender, and age), language interpreter use, and consultation related information such as age at first visit, age at first surgery, and number of reoperations, were recorded. Differences between variables were analyzed.

Results : 376 patients were included. Median age at first visit was 1.2 years. Of the total cohort 42.2% were Hispanic/Latino, followed by 23% African American and 20.8% Caucasian. 14% belonged to other races/ethnicities. Caucasian patients were significantly younger during their first evaluation visit (P = 0.012) and accounted for the majority of privately insured patients (P <0.001). African American, Hispanic and Other race patients were significantly older at the time of first surgery (P = 0.004). Interestingly, patients of these ethnicities also showed a higher number of reoperations; however, this trend was not statistically significant.
Comparison between patients with private vs. Medicaid insurance revealed that privately-insured patients were younger at the time of first surgery (P = 0.030). Further analysis between variables and reoperation rates showed that patients who needed an interpreter (28.7% vs. 15.4%, P = 0.017) and those ≥1.5 years of age at time of surgery (26.4% vs. 14.3%, P = 0.023) had a higher number of reoperation procedures.

Conclusions : Our analysis shows that patients with private insurance are younger at the time of initial surgery. Furthermore, children with NLDO who were ≥1.5 years of age at time of surgery or those who required an interpreter, had a higher rate of reoperations – suggesting difficulties with understanding necessary postoperative care needed to prevent the closure of the recently opened nasolacrimal duct. Thus, extra care should be taken to communicate more effectively with this sub-group of patients.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.