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Cited by 134Intraocular Surgery and LensesHealthcare Policy and ManagementOphthalmology and Visual Impairment Studies

Geographic variation in the rate and timing of cataract surgery among US communities

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Kauh, Courtney Y., Blachley, Taylor S., Lichter, Paul R., Lee, Paul P., Stein, Joshua D.·2016·JAMA Ophthalmology
DOI 10.1001/jamaophthalmol.2015.5322PMC PMC5767078
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Abstract

IMPORTANCE: Previous studies using data from the 1980s found relatively little geographic variation in cataract surgery rates across the United States. We do not know whether similar patterns hold true today, nor do we know the patient- and community-level factors that might explain any recent geographic variations in the rate and timing of cataract surgery. OBJECTIVE: To assess the extent of geographic variation in patient age at initial cataract surgery and the age-standardized cataract surgery rate in a large group of insured US patients with cataracts. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of 1 050 815 beneficiaries older than 40 years of age with cataracts who were enrolled in a nationwide managed-care network during the period from 2001 to 2011. The data analysis was started in 2014 and refined in 2015. MAIN OUTCOMES AND MEASURES: Median age at initial cataract extraction, age-standardized cataract surgery rate, and time from initial diagnosis to first surgery for patients with cataracts were compared among 306 US communities. Multivariable regression modeling generated hazard ratios (HRs) with 95% CIs identifying factors associated with patients' likelihood of undergoing cataract surgery. RESULTS: A total of 243 104 patients with cataracts (23.1%) underwent 1 or more surgical procedures (55.1% were female patients). Communities with the youngest and oldest patients at initial surgery differed in age by nearly 20 years (59.9-60.1 years in Lansing, Michigan, and Aurora, Illinois, vs 77.0-79.6 years in Marquette, Michigan; Rochester, New York; and Binghamton, New York). The highest age-standardized cataract surgery rate (37.3% in Lake Charles, Louisiana) was 5-fold higher than the lowest (7.5% in Honolulu, Hawaii). The median time from initial cataract diagnosis to date of first surgery ranged from 17 days (Victoria, Texas) to 367 days (Yakima, Washington). Compared with white patients, black patients had a 15% decreased hazard of surgery (HR, 0.85 [95% CI, 0.83-0.87]), while Latino patients (HR, 1.08 [95% CI, 1.05-1.10]) and Asian patients (HR, 1.09 [95% CI, 1.05-1.12]) had an increased hazard. For every 1° higher latitude, the hazard of surgery decreased by 1% (HR, 0.99 [95% CI, 0.98-0.99]). For every additional optometrist per 100 000 enrollees in a community, the hazard of surgery increased 0.1% (HR, 1.001 [95% CI, 1.001-1.001]). CONCLUSIONS AND RELEVANCE: In recent years, patient age at first cataract surgery and the age-standardized surgery rate have varied considerably among some US communities. Future research should explore the extent to which such variations may affect patient outcomes.

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  • With 3.8 million cataract procedures performed every year in the United States, medications potentially totaling $560 million are needlessly discarded.

    “With 3.8 million cataract procedures performed every year in the United States, medications potentially totaling $560 million are needlessly discarded.76,77”

    From How Ophthalmologists Can Decarbonize Eye Care (2023) · cites this paper as [77]

    The Results report cataract surgeries among enrollees in a managed-care network, not an annual US total. Searches for 3.8 million procedures and $560 million in discarded medications found no passage addressing either figure or medication waste; the cited paper cannot verify this claim. (LLM, conf=0.76)

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  1. [14]Rothman KJ Greenland S Lash TL Modern Epidemiology 3 Philadelphia, PA Wolters Kluwer Health/Lippincott Williams & Wilkins 2008

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Authors
Kauh, C. Y., Blachley, T. S., Lichter, P. R., Lee, P. P., & Stein, J. D.
Affiliations
University of Michigan (US)
Corresponding author
Stein, Joshua D.
ORCID
Venue
JAMA Ophthalmology
Publisher
American Medical Association (AMA)
Published
2016-03-01
Volume
134
Issue
3
Pages
267
ISSN
2168-6165 (ISSN-L)
DOI
10.1001/jamaophthalmol.2015.5322
PMC
PMC5767078
OpenAlex
W2221645771
Cited by
134
References
39
Citations by year
2026: 10 · 2025: 23 · 2024: 29 · 2023: 12 · 2022: 14 · 2021: 16 · 2020: 9 · 2019: 8 · 2018: 5 · 2017: 6 · 2016: 2
FWCI
4.16
Type
journal article
Language
en
Open access
Locations
  • JAMA Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Research to Prevent Blindness (1K23EY019511)
  • W.K. Kellogg Foundation
  • National Eye Institute (K23EY019511)
Topics
  • Health Sciences › Medicine › Ophthalmology › Intraocular Surgery and Lenses
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
Keywords
cataract surgery, regional variation, age at surgery, time to surgery, cataract diagnosis, racial disparities, Hispanic patients, managed care, Medicare beneficiaries, health care utilization, community factors, insurance status, urban-rural differences, quality of care
MeSH terms
Adult, Aged, Aged, 80 and over, Cataract, Cataract Extraction, Cross-Sectional Studies, Ethnicity, Female, Geography, Humans, Male, Managed Care Programs, Middle Aged, Practice Patterns, Physicians', Retrospective Studies, Time Factors, United States, Age Distribution, Sex Distribution

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