Factors Contributing to Disparities in Visual Acuity Prior To Cataract Surgery: An IRIS® Registry Analysis

Abstract Purpose Access to and utilization of cataract surgery varies nationally. The purpose of this study was to characterize sociodemographic factors that predict best corrected visual acuity (BCVA) at the time of cataract surgery. Design: Retrospective cohort study. Methods This is a multicenter study of nearly 2.4M patients ≥ 50 years of age in the national IRIS® (Intelligent Research in Sight) Registry who had ≥ one BCVA measurement six months preceding cataract surgery. Estimating the relationship between race and ethnicity and preoperative BCVA, within and between ophthalmology practices, was the main outcome measure. Results Within a practice, preoperative BCVA was approximately 0.05 logarithm of the minimum angle of resolution (logMAR) lower for patients identified as White compared to all other racial and ethnic groups (p < 0.002). Uninsured and Medicaid-insured patients had worse preoperative BCVA (1.150, 0.097 logMAR higher, p = 0.006, 0.001, respectively). Between practices, a patient in a practice serving 10 percent more patients identified as Asian, Black, or Hispanic had higher preoperative BCVA, holding constant an individual’s race and ethnicity (0.009, 0.012, 0.014 logMAR higher, respectively, all p = 0.002). Conclusions Our results suggest that patients who do not identify as White, uninsured, and Medicaid-insured patients, will have worse vision prior to cataract surgery. Further, we observed that patients seen at practices serving a higher percentage of patients identified as Asian, Black, or Hispanic will have worse preoperative BCVA. These findings highlight the need for initiatives to address disparities in ophthalmic care.