Abstract
Purpose :
Cataracts are one of the leading causes of vision impairment (VI) in the U.S. with unoperated cataracts carrying a significant risk of VI or blindness. Health disparities that disproportionally affect individuals according to their race/ethnicity and sociodemographic factors have been documented in several ophthalmic conditions. We sought to identify if there were differences in the severity of VI prior to cataract surgery according to race/ethnicity and sociodemographic factors.
Methods :
Demographic and clinical data from adults aged ≥18 years who underwent cataract surgery at the Wilmer Eye Institute, Johns Hopkins Hospital were extracted from 2017-2019. Best recorded visual acuity (BRVA) was used to define VI, with mild VI defined as BRVA 20/40 or better and severe VI defined 20/200 or worse. In patients with bilateral cataracts, the eye with the worse vision was selected for analysis. A multinomial logistic regression analysis was performed to assess various sociodemographic factors along with race/ethnicity according to patients’ VI severity.
Results :
Our study population consisted of 15,353 patients. The majority were female (58.1%), Non-Hispanic (NH) White (67.6%), with private insurance (63.3%). In our unadjusted analysis, patients who were Black/African-American (OR, 2.15; 95% CI, 1.92-2.42), Asian (OR, 1.79; 95% CI, 1.38-2.31), or Hispanic (OR, 3.43; 95% CI, 2.53-4.64) were more likely to have severe VI compared to NH White patients, p<.001 for all. Those who were Non-English speaking (OR, 4.25; 95% CI, 3.33-5.43; p<.001) were more likely to have severe VI compared to English-speaking patients. Compared with private insurance, those with Medicaid (OR, 4.48; 95% CI, 3.84-5.23; p<.001) were more likely to have severe VI. Compared to those living in a more advantageous neighborhood, those living in a disadvantaged neighborhood were more likely to have severe VI (OR, 2.96; 95% CI, 2.45-3.59; p<.001).
Conclusions :
Our study found that racial/ethnic underrepresented groups, those who did not speak English, had Medicaid insurance, and lived in a more disadvantaged neighborhood were more likely to have severe VI prior to undergoing cataract surgery. This can help identify populations at risk for VI secondary to cataracts where improving barriers to surgical care access can yield the most benefit.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.