Patient and Practice Level Visual Acuity Prior to Cataract Surgery: An IRIS® Registry (Intelligent Research in Sight) Analysis

Purpose To examine the influence of patient demographic characteristics and ophthalmic practice composition on access to cataract surgery in the United States as measured by preoperative best-corrected visual acuity (BCVA). Patient and methods This retrospective cohort study analyzed data from the IRIS® Registry (Intelligent Research in Sight) for patients age > 50 who had at least one BCVA measurement in the six months preceding cataract surgery performed between January 1, 2016, and December 31, 2020. We used a mixed-effects model to estimate the relationship between individual-level demographic factors and practice-level composition factors and preoperative BCVA.

2,387,045 individuals met inclusion criteria. The mean BCVA prior to surgery was 0.23 (SD: 0.32) logMAR. The worst pre-operative BCVA was observed in patients with Hispanic race and ethnicity while White patients had the best [0.34 (SD: 0.43), 0.21(SD: 0.30); p<0.001]. Grouping patients in terms of percentage of BCVA worse than 20/50 prior to surgery, Hispanic patients, active smokers, and uninsured patients had higher percentages of worse preoperative vision (33.7%, 23.5%, 34.9%). Analysis of compositional effects of race and ethnicity, smoking and insurance status showed that, regardless of an individual patient’s demographic, patients treated at practices serving higher proportions of White patients showed better BCVA (b = −.008 per 10 percentage points, P < .001) while patients at practices with higher percentages of actively smoking patients showed worse BCVA (b=-0.016 per 10 percentage points active smoking patients, P < .001). There was no compositional effect of insurance status.

and Relevance Overall differences exist with regard to the visual acuity at which cataract surgery is initiated at both the level of the individual patient and the composition of practice in which they are treated. Plain Language Summary Demographic disparities and geographic variation in access to cataract surgery in the United States have been previously described in large national studies of insurance data. Smaller studies of single institutions expanded upon these studies by showing differences in preoperative visual acuity- an important measure of access to cataract surgery- based on factors such as race and insurance status but were limited by the size and scope of their study patients. The IRIS® Registry (Intelligent Research in Sight) is the nation’s first comprehensive ophthalmic clinical registry with data from both individual patients as well as ophthalmic group practices. Using data from this registry, we show differences in preoperative visual acuity prior to cataract surgery at both the level of the patient and the practice in which they are treated. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the Massachusetts Eye and Ear Clinical Data Science Fund. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: MEE Ophthalmology From: Partners Human Research 399 Revolution Drive, Suite 710 Somerville, MA 02145 Title of Protocol: IRIS Registry Database Project IRB Review Type: Expedited IRB Review Date 02/12/2020 IRB Review Action: Not Human Subjects Research The IRB has determined that this activity does not meet the definition of human subjects research. This determination was based on the PHRC Policy Definition of Human-Subjects Research. Continuing review is not required. The investigators conducting this research will not obtain data through an intervention or interaction with individual subjects or identifiable private information about living individuals. Identifiable private information means that the identity of the individual is or may readily be ascertained by the investigators conducting the research, or is associated with the information. Note: If you are receiving coded data/specimens, please obtain a signed letter of agreement from the provider of the data/specimens stating that you will never be given access to the key to the codes that contains identifiers that could be used to link the samples/data to individual subjects who provided the samples/data. The IRB does not need a copy of this letter of agreement. GENERAL REVIEW COMMENTS: The IRB reviewed and determined that this project does not meet the definition of Human subject Research. Partners Human Research Partners HealthCare 399 Revolution Drive, Suite 710 Somerville, MA 02145 Tel: 857-282-1900 Fax: 857-282-5693 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data referenced in this manuscript are derived from the American Academy of Ophthalmology IRIS Registry. The Registry is a de‑identified, HIPAA‑compliant clinical database comprising tens of millions of patient encounters and accessible to researchers via AAO-approved pathways.