Eyeworld

SUMMER 2026 | EYEWORLD | 25 Contact Lindsey: jllindsey@meei.harvard.edu enrolled in Medicare Advantage, whose claims are not captured in this dataset. 8 Additionally, cross-sectional observational studies cannot prove causal relationships, although this study adds onto the prior body of work that demon- strates similar findings at group or population levels. Results may also not be generalizable beyond Medicare-aged populations or to pa- tients with private insurance, although the vast majority of cataracts are sequelae of aging, and patients with non-Medicare insurance likely face similar geographic hurdles. This study was also restricted to analyzing a single-state Medicare population, although California is the most urban state in the U.S., in which 94.2% of the population resides within urban areas accord- ing to 2020 Census data. 9,10 While national level research would be of utility, the results of this study pose great implications for states or regions with greater proportions of rural residents. The strengths of this study include the utilization of a large and ethnically/racially diverse data set with individual data that allows for novel geospatial and effect modification analyses. Conclusion This study demonstrated that rural Californian beneficiaries traveled greater distances and spent more time traveling for cataract surgery, which can significantly reduce their odds of undergoing the procedure. Interestingly, the as- sociation between increased travel distance and decreased odds of cataract surgery was most pronounced in Black and Hispanic/Latino ben- eficiaries, suggesting that geographic barriers accentuate gaps in surgical access along racial and ethnic lines. The authors propose numerous solutions to mitigate these issues, including sub- sidizing travel, expanding teleophthalmology, investing in targeted community outreach, and increasing ophthalmology resources in under- resourced communities. They also suggest the need for further studies analyzing factors such as geographic residence, socioeconomic status, race, and ethnicity, and their effects on access to ophthalmic surgical care. References (continued) 8. Jacobson G, et al. Medicare Advantage 2017 Spotlight: En- rollment Market Update. Kaiser Family Foundation. Published 2017. www.kff.org/medicare/ medicare-advantage-2017- spotlight-enrollment-market- update/. 9. Johnson H, Cuellar Mejia M. Rural California. Public Policy Institute of California. March 2023. www.ppic.org/publication/ rural-california/. 10. US Census Bureau. Nation's Urban and Rural Populations Shift Following 2020 Census. Published December 29, 2022. www.census.gov/newsroom/ press-releases/2022/urban-ru- ral-populations.html. Geographical barriers to surgical treatment for cataract among California Medicare beneficiaries Murillo K, et al. J Cataract Refract Surg. 2026;52:544–550. n Purpose: To examine geographic factors associated with the likelihood of receiving cataract surgery. n Setting: Administrative claims data from 2017 California Medicare Database. n Design: Cross-sectional. n Methods: Beneficiaries were included if they were 65 years or older, had a valid postal code, active coverage with Medicare parts A and B, and cataract diagnosis defined by International Classification of Diseases, 10th Revision, Clinic Modification (ICD-10- CM) codes. Cataract surgery was defined using billing codes. The association between rural residence and distance and time traveled for cataract surgery was assessed using linear regression models. The odds of receiving cataract surgery were estimated using logistic regression models. n Results: Among 445,164 beneficiaries with cataract, 127,314 (28.6%) reported rural residency. Rural residence was associated with increased travel time and distance for cataract surgery (+0.16 hours [95% confidence interval (CI): 0.15–0.17]; +9.7 miles [95% CI 9.3–10.2]). For every additional 100 miles traveled, odds of cataract surgery decreased by 14% (adjusted odds ratio (aOR): 0.86; 95% CI: 0.84–0.87). Stratified analysis demonstrated that Black beneficiaries had the greatest reduced odds of cataract surgery per each 100 additional miles traveled (aOR: 0.38; 95% CI: 0.31– 0.45), followed by Hispanic/Latino beneficiaries (aOR: 0.67; 95% CI: 0.63–0.72). n Conclusions: Beneficiaries living in rural California had increased travel distance and time for cataract surgery. Black beneficiaries had the strongest association between increased travel distance and decreased odds of cataract surgery. These findings suggest possible disparities in surgical treatment for cataract among rural populations. Further studies are needed to better understand and address geographic disparities to eyecare.

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