Patients who are Hispanic or have publicly subsidized insurance may be predisposed to a decreased access to care, which can negatively impact their vision. These are the findings of a study published in Eye Contact Lens by a group of researchers from the department of Cornea and Refractive Surgery, Shiley Eye Institute in the University of California, San Diego.

The investigators led a single-center retrospective chart review study at their eye clinic that evaluated data collected from the appointment immediately preceding cataract surgery from 600 patients. Researchers looked at best-corrected visual acuity (BCVA) in the operated eye converted to the logarithmic minimal angle of resolution (logMAR), insurance coverage, race, sex, age, body mass index, smoking status, systemic and ocular comorbidities and ocular surgical history. The study used the preoperative BCVA in the operated eye as the main outcome measure.

Study subjects were predominately white (59.3%). Other races represented in the study were Asian (7.1%), black (5.4%), Hispanic (12%), and other (16.1%). Within the overall study population, 49.4% of patients received Medicare Advantage at the point of surgery, whereas traditional Medicare beneficiaries accounted for 5.1% of the population (this does not include the 10.9% of the population who received Medicaid and Medicare coverage as dual eligible beneficiaries).

Researchers found significant differences in BCVA between groups by insurance type (public, private and uninsured), race (Asian, black, Hispanic, white and other), and sex. The study noted better BCVA was associated with white race (0.85, logMAR [Snellen 20/140]) over Hispanic race (1.06, [20/230],), and better BCVA was associated with private insurance (0.79, [20/125]) vs. public insurance (0.96, [20/180]).

The association between public insurance and worse preoperative BCVA indicates a disparity in care utilization by insurance type, researchers noted. The explanation for this association could relate to the influence of insurance product structure, such as network type (e. g., HMO and PPO), and cost sharing on patients and referring physicians, they added.

Since Hispanics represent the largest and fastest-growing minority group in the United States, the development of appropriate public health interventions aimed at decreasing health disparities for this group will only rise in importance as the population grows, the study reported.

“Understanding how to target eye health interventions and how to measure their success is paramount. The same is true for the publicly insured, particularly in the wake of Medicaid expansion through the Affordable Care Act,” researchers said. “By developing and executing more precise preventive eye care interventions, tailored to the needs of these vulnerable populations, we can diminish the toll undue vision loss takes on patient lives, physician practices, and the broader health system.”

Stone JS, Fukuoka H, Weinreb, RN, et al. Relationship between race, insurance coverage, and visual acuity at the time of cataract surgery. Eye Contact Lens. 2018 Nov;44(6):393-98.