February 2010




Unmet cataract need found in Latino community

by Maxine Lipner Senior EyeWorld Contributing Editor


Study finds high prevalence of cataracts among Latinos

Within the Latino community in Los Angeles there is already a large unmet need for cataract surgery, which is only going to grow with time, according to Rohit Varma, M.D., professor of ophthalmology and preventive medicine, Doheny Eye Institute, University of Southern California, Los Angeles. In a study published in the October 2009 issue of Ophthalmology investigators reported on the prevalence of visually significant cataracts in the U.S. Latino population and behaviors that led to an unmet need in this population.

This particular study was an outgrowth of a much larger program—the Los Angeles Latino Eye Study (LALES). “A few years ago when I started the LALES there was no data on Latino eye disease in the U.S.,” Dr. Varma said. “At that point what was clear was that this was the fastest growing segment of the U.S. population.” Since then Latinos have become not only the fastest growing but also the largest ethnic group in the U.S. “It is clearly important to know what their eye disease characteristics are and where the need is in the group,” Dr. Varma said. “What is very interesting is that they’re one of the youngest ethnic groups in the U.S., with an average age of somewhere in the 20s. What that means is that over the next 20 to 40 years as the group ages there is going to be a huge burden of eye disease.”

In addition, the Latino population also has significantly high rates of diabetes. “In our group almost a quarter of the people age 40 and older have diabetes,” Dr. Varma said. “Diabetes is associated not just with retinopathy but also with increased risk of cataract and glaucoma.”

Gathering community data

Included in the study were 6,142 Latinos, 40 years and older, from six contiguous census tracts in Los Angeles. Investigators chose those particular tracts because they had a high proportion of Latinos living there. For the study they went door to door identifying everyone age 40 and older who called themselves Latino. Those people were given an interview in the house and invited to come to a local clinic for an eye examination. “Over 80% of them came in and got an eye examination,” Dr. Varma said. Those who came in for the exam were included here.

Investigators gathered socio-demographic data centering on when patients had their last eye exam and why. They assessed the patients’ presenting and best-corrected visual acuity and performed a slit lamp examination to identify the type, grade, and severity of the cataract. In addition, to be considered visually significant the cataract had to be identified as the primary cause of visual impairment and the patient had to report that his vision was fair, poor, very poor, or that he was blind.

Using these stringent criteria, about 2% of all patients were found to have visually significant cataracts. This varied by age. “It went from approximately 0.25% in those age 40 to 49 all the way up to 17% in those age 80 and older,” Dr. Varma said.

Practitioners also identified what they called an “unmet need” for cataract surgery. “Those participants in whom there was a visually significant cataract in at least one eye or those who had had cataract surgery in at least one eye were considered to be people who would need it in the other eye,” Dr. Varma said. “Those were the ones who we called the ‘at risk’ group, and of them, one-third had an unmet need for cataract surgery.”

Investigators were surprised by the extent of the unmet need. “We didn’t think that there was a large unmet need in the U.S.,” he said. “Cataract extraction is one of the dominant operations that Medicare pays for—it’s very common.”

Risk indicators

Delving deeper, investigators found independent risk indicators for having unmet need. Some of the variables considered were factors such as whether patients had health insurance, whether they had seen a practitioner at an eye care clinic, and whether they had barriers to obtaining eye care.

“We found that if they did not have health insurance they were almost three times as likely to have an unmet need,” Dr. Varma said. “The unmet need was almost three times greater if the household income was less than $20,000. They had almost a two-fold higher risk of having this if they reported barriers to obtaining eye care.”

When investigators extrapolated this data nationwide they found a significant amount of unmet need. “There are about 180,000 U.S. Latinos who have an unmet need,” Dr. Varma said. “This is a reversible, treatable condition, and cataract surgery is one of the most successful operations in ophthalmology. If doctors take these lenses out they can give people the ability to see better.” This in turn will make those people better able to contribute to the work force and beyond.

Overall, Dr. Varma sees these results as a call to action. “Obviously we have to target this particular group and intervene to help them see better, which will then allow them to become more productive members of society,” he said.

Editors’ note: Dr. Varma has no financial interests related to his comments.

Contact information

Varma: Rvarma@usc.edu

Unmet cataract need found in Latino community Unmet cataract need found in Latino community
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