Healthcare disparities contribute to missed follow-up visits after cataract surgery in the USA: results from the perioperative care for intraocular lens study

Abstract

ObjectiveTo identify factors that contribute to missed cataract surgery follow-up visits, with an emphasis on socioeconomic and demographic factors.MethodsIn this retrospective cohort study, patients who underwent cataract extraction by phacoemulsification at Massachusetts Eye and Ear between 1 January and 31 December 2014 were reviewed. Second eye cases, remote and international patients, patients with foreign insurance and combined cataract cases were excluded.ResultsA total of 1931 cases were reviewed and 1089 cases, corresponding to 3267 scheduled postoperative visits, were included. Of these visits, 157 (4.8%) were missed. Three (0.3%) postoperative day 1, 40 (3.7%) postoperative week 1 and 114 (10.5%) postoperative month 1 visits were missed. Age<30 years (adjusted OR (aOR)=8.2, 95% CI 1.9 to 35.2) and ≥90 years (aOR=5.7, 95% CI 2.0 to 15.6) compared with patients aged 70–79 years, estimated travel time of >2 hours (aOR=3.2, 95% CI 1.4 to 7.4), smokers (aOR=2.7, 95% CI 1.6 to 4.8) and complications identified up to the postoperative visit (aOR=1.4, 95% CI 1.0 to 2.1) predicted a higher rate of missed visits. Ocular comorbidities (aOR=0.7, 95% CI 0.5 to 1.0) and previous visit best-corrected visual acuity (BCVA) of 20/50–20/80 (aOR=0.4, 95% CI 0.3 to 0.7) and 20/90–20/200 (aOR=0.4, 95% CI 0.2 to 0.9), compared with BCVA at the previous visit of 20/40 or better, predicted a lower rate of missed visits. Gender, race/ethnicity, language, education, income, insurance, alcohol use and season of the year were not associated with missed visits.ConclusionsMedical factors and demographic characteristics, including patient age and distance from the hospital, are associated with missed follow-up visits in cataract surgery. Additional studies are needed to identify disparities in cataract postoperative care that are population-specific. This information can contribute to the implementation of policies and interventions for addressing them.

Inequities and Research Gaps in Ophthalmology

“…There was conflicting evidence over follow-up appointment adherence being associated with race and ethnicity. Six studies found that White patients were more likely to follow up with an ophthalmologist than American Indian and Alaska Native, Asian, Black, Hispanic, and Native Hawaiian and Other Pacific Islander patients and patients of unreported race; conversely, 3 studies found no significant association between race and ethnicity and follow-up adherence . Pineles et al reported that White patients were more likely to be diagnosed with eye diseases than patients of other races.…”

“…Women were less likely to undergo certain ophthalmic surgical procedures. 55,56 In contrast, 11 studies found no association between sex and/or gender and ophthalmic conditions, 30,34,[57][58][59][60] follow-up adherence, 23,[27][28][29] or access to eye care. 37 Further findings can be found in the eTable in the Supplement.…”

“…Six studies found that White patients were more likely to follow up with an ophthalmologist than American Indian and Alaska Native, Asian, Black, Hispanic, and Native Hawaiian and Other Pacific Islander patients and patients of unreported race [21][22][23][24][25][26] ; conversely, 3 studies found no significant association between race and ethnicity and follow-up adherence. [27][28][29] Pineles et al 30 reported that White patients were more likely to be diagnosed with eye diseases than patients of other races. Several studies found that Hispanic individuals were more likely to develop chalazion, 31 cataracts, 32 myopia, 33 diabetic retinopathy, 34 and visual impairments 35,36 than White individuals; however, Hispanic individuals were less likely to adhere to annual eye examinations compared with other races.…”

“…46 In contrast, other studies found that education was not associated with dia-betic retinopathy awareness 69 or with follow-up adherence for ophthalmic care. 27,28 Additional information can be found in the eTable in the Supplement.…”

Social Determinants of Health Data Availability for Patients with Eye Conditions

“… 8 , 9 Healthcare disparities may also contribute to worsened postoperative care in patients who receive cataract surgery. 10 The relationship between SDoH and ophthalmic conditions also is bidirectional; Constantino et al 8 and Brezin et al 11 reported that low visual acuity could in fact be a risk factor for socioeconomic factors such as adverse social outcomes, worsened mental health, and poverty. 12 …”