Impact of Patient Race on Cataract Surgery Outcomes in a Safety Net Academic Medical Center.

Abstract

Objective: Investigate the impact of race and specific social determinants of health, including income and insurance status, on visual acuity outcomes for cataract surgery in a Midwest safety net academic medical center.

Design: Retrospective chart review.

Setting: University of Cincinnati Eye Clinic, a safety net academic medical center.

Patients or participants: Records of first-time unilateral cataract surgeries performed between January 2015 and August 2020 were analyzed, with comparisons between Black and White patients.

Methods: Statistical analyses included chi-square tests, t tests, analysis of variance, and linear regression models, with a significance threshold of α=.05.

Main outcome measures: Postoperative uncorrected visual acuity (UCVA), postoperative refractive error (cylinder and sphere), and prevalence of comorbid conditions such as glaucoma and diabetic retinopathy.

Results: Black patients had lower median incomes (P=.0001), worse postoperative UCVA (P=.014, 95% confidence interval [CI]: .016, .147), higher postoperative cylinder (P=.003, 95% CI: .092, .454), more myopic postoperative sphere (P=.017, 95% CI: -.829, -.083), and higher rates of glaucoma (P=.001) and diabetic retinopathy (P=.001). Adjusting for confounders, race was not independently associated with postoperative UCVA (P=.342).

Conclusions: Although Black patients demonstrated worse postoperative UCVA, these disparities were linked to comorbidities and social determinants of health rather than race itself. These findings emphasize the importance of addressing nonracial determinants for improving visual acuity outcomes.