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

• Published in: BMJ open 2021-03, Vol.11 (3), p.e038565-e038565
• Main Authors: Moustafa, Giannis A, Borkar, Durga S, Eton, Emily A, Koulisis, Nicole, Kloek, Carolyn E, Borboli-Gerogiannis, Sheila, Brauner, Stacey, Peggy Chang, H., Chang, Kenneth, Chen, Sherleen H., Gardiner, Matthew, Greenstein, Scott H., Kloek, Carolyn E., Lobo, Ann-Marie, Katie Luo, Z.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol use; Cataract - epidemiology; cataract and refractive surgery; Cataract Extraction; Cataracts; Data collection; Education; Ethnicity; Eye surgery; Follow-Up Studies; Gender; health services administration & management; Healthcare Disparities; Humans; Lenses, Intraocular; Massachusetts; Ophthalmology; organisation of health services; Patients; Perioperative Care; Phacoemulsification; Public health; Retrospective Studies; social medicine; Socioeconomic factors; Surgeons; United States - epidemiology; Variables
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-038565

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. Age2 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.