Relationship Between Race, Insurance Coverage, and Visual Acuity at the Time of Cataract Surgery

To assess the relationship between sociodemographic variables (including race, age, and insurance coverage) and preoperative best-corrected visual acuity (BCVA) at the time of first-eye cataract surgery.

Single-center retrospective chart review study at Shiley Eye Institute, University of California, San Diego (UCSD). Medical record data from 600 patients were collected from the appointment immediately preceding cataract surgery, including BCVA in the operated eye converted to the logarithmic minimal angle of resolution (logMAR), insurance coverage, race, sex, age, body mass index, smoking status (including pack years), systemic and ocular comorbidities, and ocular surgical history. Preoperative BCVA in the operated eye was the main outcome measure.

Univariate analysis revealed significant differences in BCVA between groups by insurance type (public, private, and uninsured), race (Asian, black, Hispanic, white, and other), and sex (male and female) (P<0.001, P<0.001, and P=0.019, respectively). Further multivariate analysis revealed significant pairwise differences, with better BCVA associated with white race (0.85, logMAR [Snellen 20/140]) than Hispanic race (1.06, [20/230], P=0.017), and better BCVA associated with private insurance (0.79, [20/125]) versus public insurance (0.96, [20/180], P=0.0002).

Hispanic race and public insurance coverage were each associated with worse preoperative BCVA compared with white race and private insurance, respectively. This suggests that Hispanic race and public insurance may predispose patients to decreased access to cataract surgery. Additional large, prospective studies are required to rigorously test and elaborate on this finding.