Eyeworld

DECEMBER 2023 | EYEWORLD | 19 References 1. Dickman SL, et al. Inequality and the health-care system in the USA. Lancet. 2017;389:1431– 1441. 2. Bailey ZD, et al. Structural rac- ism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–1463. 3. Derose KP, Baker DW. Limited English proficiency and Latinos' use of physician services. Med Care Res Rev. 2000;57:76–91. 4. DuBard CA, Gizlice Z. Lan- guage spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98:2021–2028. 5. Fernandez A, et al. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabe- tes Study of Northern California (DISTANCE). J Gen Intern Med. 2011;26:170–176. 6. Fiscella K, et al. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40:52–59. 7. Flores G, et al. Limited English proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters. Public Health Rep. 2005;120:418–430. Discussion Though challenges with language discordance have been documented in other medical fields, there is limited literature within ophthalmolo- gy. The findings presented by Gill et al. exhibit preoperative, intraoperative, and postoperative disparities in cataract surgery between LEP and EP patients. LEP patients were more likely to have complex surgeries with a higher CDE even when adjusting for mature cataracts. Initially, this inequity may seem expected because LEP patients were more likely to have type 2 diabe- tes, which is associated with poor dilation and the need for iris manipulation, classifying it as a complex surgery under the authors' defini- tion. Interestingly, however, these associations persisted despite adjusting for type 2 diabetes and surgeon type. Additionally, Gill et al. found that LEP patients were more likely to require diabetic retinopathy, worse preoperative CDVA, mature cataracts, to be designated as a complex surgery, and to receive higher CDE intraopera- tively. All of these characteristics were statisti- cally significant (p<.0001). LEP patients were also more likely to have resident physicians perform their surgeries (p<.0005). Differences between LEP and EP patients with regard to complex surgeries and CDE levels remained statistically significant even after adjustment for mature cataracts (p<.0001). Postoperatively, LEP patients showed greater improvement in CDVA (p<.0001), were less likely to undergo Nd:YAG capsulotomy (p<.0001), and were more likely to be using steroid eye drops 4 weeks postoperatively (p<.0002). Subanalyses of Hispanic, African American, and Asian pa- tients rarely revealed statistical significance due to small sample sizes; however, all of these LEP subgroups' results trended in the same direction as the LEP cohort as a whole. continued on page 20 From left: Matthew Regueiro, MD, Jeffrey Goshe, MD, Chad Serels, MD Source: Cleveland Clinic Cole Eye Institute

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