Eyeworld

24 | EYEWORLD | SUMMER 2026 ASCRS NEWS received cataract surgery. Of those who un- derwent cataract surgery, 61,069 (63.3%) were White, 3,013 (3.2%) were Black, 11,966 (12.8%) were Asian, 13,946 (14.9%) were Hispanic/Latino, and 3,466 (3.7%) were Other. Of the beneficiaries who received cataract surgery, 27,587 (29.5%) met the rural residen- cy designation. Among the beneficiaries with cataracts, there were statistically significant differences in age (P<0.0001), race and ethnic- ity (P<0.0001), sex (P=0.03), and CCI score (P<0.0001) between those who did and did not receive cataract surgery. Even when adjusted for age, sex, CCI, race, and ethnicity, linear regression models demon- strated statistically significant differences in distance (9.7 [95% CI: 9.3–10.2] additional miles) and time (0.16 [95% CI: 0.15–0.17] additional hours) for rural versus non-rural beneficiaries when traveling for cataract surgery. When controlling for rural versus non-rural residence among beneficiaries with cataracts, each additional 100 miles of travel distance was associated with a 14% decreased adjusted odds of cataract surgery (adjusted odds ratio [aOR]: 0.86, 95% CI: 0.84–0.87), while each additional hour of travel time was associated with 6% de- creased adjusted odds of cataract surgery (aOR: 0.94, 95% CI: 0.93–0.95). Stratification by race and ethnicity revealed a statistically significant interaction between travel distance and the adjusted odds of cataract surgery (P<0.0001). For every additional 100 miles of travel distance to cataract surgery, the adjusted odds of undergoing cataract surgery decreased by 62% in Black beneficiaries (aOR: 0.38 [95% CI: 0.31–0.45]), 33% in Hispan- ic/Latino beneficiaries (aOR: 0.67 [95% CI: 0.63–0.72]), 19% in Asian beneficiaries (aOR: 0.81, [95% CI: 0.76–0.87]), and 8% in White beneficiaries (aOR: 0.92, [95% CI: 0.90–0.94]). Discussion Geographic barriers to healthcare decrease uti- lization, raise costs, and increase morbidity for patients, especially for those in need of cataract surgery. Prior group-level research has explored this association but cannot fully ascertain why and for whom disparities may exist. In this cross-sectional study using a 2017 California Medicare claims data set, Murillo et al. found significant geographic barriers to cataract sur- gery at the individual patient level, which were further exacerbated when stratifying results by race and ethnicity. After adjusting for age, sex, CCI, race, and ethnicity, the study found that rural residents traveled significantly more than non-rural residents, on average an additional 9.7 miles and 9.6 extra minutes. Importantly, the authors also found that every additional 100 miles of travel was associated with 14% decreased odds of receiving cataract surgery (aOR 0.86, 95% CI 0.84–0.87) and that every additional hour decreased odds by 6% (aOR 0.94, 95% CI 0.93–0.95). These results demonstrate that rural Californians face greater travel burdens for cataract surgery, and increased travel is independently associated with lower likelihood of undergoing surgery. The authors infer that this may be due to scarcity of ophthalmologists in rural areas, which is supported by a separate study that found that only 9.1% of cataract surgeons are located in non-metropolitan areas. Notably, undergoing cataract surgery has been shown to reduce morbidity and mortality, such as rate of hip fractures, motor vehicle accidents, dementia, and depression. 4–7 Delay in undergo- ing cataract surgery may thus have significant implications for systemic health and well-being. In the analysis of effect modification of this relationship between geography and cataract surgery by race/ethnicity, the authors found that Black and Hispanic/Latino individuals were disproportionately affected by geograph- ic barriers. For every 100 additional miles of travel, odds of surgery decreased by 33% for Hispanic/Latino patients and 62% for Black patients. Within this context, the authors high- light a critical need to analyze and subsequently address individual and structural level social determinants of health, such as better distribu- tion of ophthalmologists, greater investment in minority communities, and creation of safety net programs that ease transportation barriers. Key limitations of this study include the fact that claims data does not capture other unmeasured confounders such as actual clinical need for surgery. For example, patients with only mild and asymptomatic cataracts would not meet surgical criteria, which could partially explain rural-urban differences in surgery rates independent of access barriers. Claims data also cannot capture patient preference or supple- mental coverage. For example, approximately one-third of 2017 Medicare beneficiaries were continued from page 23 References 1. Ellwein LB, Urato CJ. Use of eye care and associated charges among the Medicare population: 1991–1998. Arch Ophthalmol. 2002;120:804–811. 2. National Eye Institute. NEI charts a clearer future for cata- ract prevention and treatment. Published June 29, 2017; accessed December 2, 2022. www.nei. nih.gov/about/news-and- events/news/nei-charts-clear- er-future-cataract-preven- tion-and-treatment. 3. Health Resources & Services Administration. List of Rural Counties and Designated Eligible Census Tracts in Metropolitan Counties. Health Resources & Services Administration; 2018. 4. Foss AJE, et al. Falls and health status in elderly women follow- ing second eye cataract surgery: a randomised controlled trial. Age Ageing. 2006;35:66–71. 5. Owsley C, et al. Impact of cataract surgery on motor vehi- cle crash involvement by older adults. JAMA. 2002;288:841–849. 6. McGwin G Jr, et al. The impact of cataract surgery on depression among older adults. Ophthalmic Epidemiol. 2003;10:303–313. 7. Lee CS, et al. Association between cataract extraction and development of dementia. JAMA Intern Med. 2022;182:134–141.

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