Eyeworld

SUMMER 2026 | EYEWORLD | 23 by Harold Dorsey, MD, Ayush Parikh, MD, Gavin Li, MD, Mass Eye and Ear Ophthalmology Residents, Jennifer Lindsey, MD, MBA, Residency Program Director EYEWORLD JOURNAL CLUB Eligible beneficiaries were 65 years or older, resided in California, had active Medicare Part A and B coverage, and had an ICD-10-CM diagnosis code for cataract. The main variables of interest that were evaluated included: 1) rural versus non-rural residence, 2) estimated patient-to-cataract surgery provider distance and travel time, and 3) occurrence of cataract surgery. Covariates included age, sex, race and ethnicity, and systemic disease burden estimat- ed by Charlson Comorbidity Index (CCI) score. Beneficiary residence ZIP codes were cate- gorized as rural or non-rural using Health Re- sources & Services Administration's 2010 List of Rural Counties and Designated Eligible Census Tracts in Metropolitan Counties. 3 Travel dis- tance (miles) and travel time (hours) between the patient's and the cataract surgery provid- er's ZIP code centroids were calculated using ArcGIS Pro spatial analysis. The occurrence of cataract surgery was identified via CPT billing codes. Statistical analyses were performed using SAS version 9.4. Linear regression models were used to assess the association between rural residence and travel distance and time. Sepa- rate logistic regression models were utilized to estimate the adjusted odds of receiving cata- ract surgery based on travel distance and time, controlling for age, sex, race and ethnicity, and CCI scores. To determine if the impact of travel bar- riers differed depending on a patient's race or ethnicity, multivariable logistic regression models were used to test for a connection be- tween travel distance and demographic groups (factoring in age, sex, CCI, and rural residency). If the interaction term between travel distance and race/ethnicity was statistically significant, separate logistic regression models were run for each racial and ethnic group to assess how travel distance affected that specific group's likelihood of receiving surgery. Results There were 445,164 Californian beneficiaries 65 years or older with cataracts who met this study's inclusion criteria, and 93,460 (21.0%) Review of "Geographical barriers to surgical treatment for cataract among California Medicare beneficiaries" C ataract is the most common revers- ible cause of vision impairment in the U.S. and accounts for approximately 60% of Medicare vision-related costs. 1 By 2050, the number of indi- viduals affected by cataracts in the U.S. is projected to double to nearly 50 million. 2 While cataract surgery is a highly effective intervention, studies show that factors such as race, income, and rural residency create unique barri- ers to accessing care. Conse- quently, marginalized popula- tions exhibit lower utilization of eyecare services and have a higher likelihood of undergo- ing complex cataract surgery. California, the most pop- ulous state, has a substantial rural population estimated at 2.3 million individuals. Although previous group-lev- el studies suggest decreased access to cataract surgery in rural areas, the individual-level association between geographic factors and surgical treat- ment has not been studied. This study aims to compare travel distance and time for cataract surgery among rural versus non-rural California Medicare beneficiaries and to evaluate whether these geographic barriers are associated with the likelihood of receiving surgery, particularly examining differences across racial and ethnic groups. Methods A cross-sectional study was conducted using the 2017 California Medicare Master Beneficiary Summary File and Part B Carrier Claim files. EyeWorld Journal Club review continued on page 24 Harold Dorsey, MD Gavin Li, MD Ayush Parikh, MD

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