This study highlights the need for addressing racial disparities in eye care access, with Black patients facing several hurdles and delays in receiving timely cataract surgery and premium IOLs. Photo: Getty Images. 

There have been quite a few studies on racial inequities regarding the intraoperative complications of cataract surgery, but less is known about the timeline for surgical scheduling and the presentation of intraocular lens (IOL) options. A new study investigated whether Black patients have a different preoperative and postoperative cataract surgery timeline and IOL selection than white patients, and it showed that racial disparities do indeed play a role. Black patients experienced more delays in receiving surgery and were far less likely to receive a premium IOL than white patients, but, interestingly, were also more adherent with post-op follow-up.

A total of 10,235 patients (83.5% white) underwent cataract surgery between 2015 and 2022. Each patient’s best corrected visual acuity, slit lamp findings and surgical timeline were recorded. IOL selection was categorized as standard or premium.

The results showed that Black patients are significantly more likely to be referred for cataract surgery at a lower visual acuity and receive surgery at later timepoint after referral for cataract surgery (120 days) compared to white patients.

“Contrary to our hypothesis, Black patients were more likely to attend their postoperative follow-up appointments on postoperative day one, day seven and day 30,” the researchers wrote in their paper on the work. “Black patients were far less likely to receive a premium IOL than their white counterparts, although the subtypes of premium IOLs that they received were not significantly different than white patients. Overall, our study is novel in that it shows Black patients currently face significant hurdles in both receiving timely cataract surgery and achieving spectacle independence from premium IOLs.”

These findings, combined with results from a previous study, suggest that racial minorities face undue burdens in both being referred for cataract surgery and having their cataract extracted. “Because the patients in this study were evaluated by time since referral rather than time since diagnosis, it is likely that many patients (especially Black patients) were tolerant of cataract-related vision impairment for a long period of time,” the authors explained.

White patients were 25%, 24% and 29% less likely to follow-up than Black patients at postoperative day one, day seven and day 30, respectively. “Although the causative factors for this relationship have yet to be elucidated, it is possible that white patients were less inclined to attend postoperative appointments than black patients because they had a superior mean logMAR postoperative visual acuity,” the authors noted.

White patients were around five times more likely to receive an advanced-optics IOL than Black patients, but the distribution of advanced IOL subtypes was not different among racial groups.

“We suspect, though, that the primary factor in premium IOL selection is financial limitation from longstanding socioeconomic disparities, which we did not control for in this study,” the authors explained. “Socioeconomic limitations impact access to care, for instance with transportation and educational opportunities, which creates barriers for patients to have equal access to these technologies. Further studies should look closer at disparities among patients who have adopted premium IOLs at the time of cataract surgery to determine causation.”

Buscho SE, Sharifi A, Cayenne S, et al. Racial disparities in cataract surgery timeline and intraocular lens selection: a retrospective study. Trans Vis Sci Technol. 2023;12(11):20. [Epub ahead of print.]