Cataract Surgery Outcomes and Postoperative Patient Compliance in Limited English Proficiency Patients at a County Hospital

Abstract

Background/AimsInvestigate the role of language barriers in cataract surgery outcomes at a county hospital.MethodsRetrospective chart review of patients who underwent cataract surgery March 2018-February 2019 at Lyndon B. Johnson Hospital. Patients who underwent cataract surgery combined with another procedure or had severe glaucoma or proliferative diabetic retinopathy were excluded. Patients were classified into limited English proficient (LEP) or English proficient (non-LEP) groups based on language preferences. Demographics, baseline ocular characteristics, intraoperative complications, postoperative BCVA (best-corrected visual acuity), complications, and compliance were recorded. The primary outcome was incidence of poor visual outcomes (BCVA<20/40) at the postoperative 1-month visit.Results354 patients (199 [56%] LEP and 155 [44%] non-LEP) with 125 (35%) males and a mean age 66.1 (±10.9) years were included. LEP patients were about 5 years older than non-LEP patients (P<0.001) and were mostly Hispanic (172 [86%] LEP vs. 36 [26%] non-LEP, P<0.001). The baseline ocular characteristics were similar (P >0.05), except severity of cataract (125 [63%] NSC grade >2+ for LEP vs 70 [51%] for non-LEP, P =0.03). No significant differences in intraoperative complications (P =0.18), incidence of poor vision (P =0.59), postoperative cystoid macular edema (P =0.32), and compliance with the postoperative drop regimen (P =0.11) were noted.ConclusionThere were no statistically significant differences in incidence of poor vision, complications, or compliance. However, there was a trend toward significance, showing that language barriers may lead to more advanced disease and compliance issues with postoperative medications.SYNOPSISLanguage barriers may lead to compliance issues with postoperative medication regimens, as shown by the difference in postoperative care adherence rates between limited English proficient and English proficient patients.

Comparison of cataract surgery outcomes in English proficient and limited English proficiency patients

“…By contrast, Yard et al demonstrated no difference in complex cataract surgery in LEP (41%) vs non-LEP (39%) patients ( P = .90). 19 In their study, LEP was defined based on a patient's documented native language. Although this definition certainly would account for those with LEP, it might also include patients who have English proficiency despite having a different native language.…”

“…For example, compared with individuals with high English proficiency, LEP patients have trouble communicating with providers, difficulty obtaining health insurance, and lower comprehension of instructions likely contributing to fewer follow-ups and lower medication adherence. 17–19…”

“…For example, compared with individuals with high English proficiency, LEP patients have trouble communicating with providers, difficulty obtaining health insurance, and lower comprehension of instructions likely contributing to fewer follow-ups and lower medication adherence. [17][18][19] According to 2013 U.S. census data, approximately 1 of 5 people reported speaking a language other than English at home. 20 Within this group, 41%, or 25.1 million people, reported having LEP.…”

“…Recently, Yard et al performed a retrospective study describing cataract outcomes in LEP and demonstrated no statistically significant differences for visual outcome, complications, or drop compliance; however, this study was relatively small and not powered to detect differences less than 10%. 19 Chen et al found that after controlling for demographic and socioeconomic factors, patients with LEP were less likely to use telemedicine for ophthalmology appointments during the COVID-19 pandemic. 22 Given that LEP has historically been associated with barriers to healthcare and poor health outcomes, we aim to further explore these inequities in the context of cataract surgery, one of the most common surgeries worldwide.…”