LEP patients' cataract surgeries were more likely to be complex (27.8% vs 15.3%)

Description #

LEP patients' cataract surgeries were nearly twice as likely to be classified as complex compared with EP patients' surgeries (27.8% vs 15.3%, P < .0001) (Table 2). Complex surgery was defined by the need for iris manipulation, anterior capsule staining for poor visualization, and/or capsular support devices.

"LEP patients' surgeries were more likely to be considered complex (27.8% vs 15.3%, P < .0001)" (Zafar, 2023, p. 595)

"Complex surgery 241 (27.8) 1941 (15.3) <.0001" (Zafar, 2023, p. 597, Table 2)

Methods Context #

What? #ⓘ

The observable: whether the cataract surgery was classified as complex, a categorical surgical characteristic with a pre-specified definition.

"Complex surgery was defined as a case which required any iris manipulation (iris hooks, Malyugin ring, and stretch pupilloplasty), anterior capsule stain due to poor visualization (trypan blue), capsular support device, and/or capsular hooks." (Zafar, 2023, p. 596)

How? #ⓘ

Retrospective comparison by LEP status using logistic regression with generalized estimating equations to account for correlation between fellow eyes of the same subject.

"Comparisons by LEP status were analyzed using logistic regression with generalized estimating equations to account for correlation between eyes from the same subject." (Zafar, 2023, p. 596)

Who? #ⓘ

13,590 eyes that underwent phacoemulsification at the University of Colorado Sue Anschutz-Rogers Eye Center (January 2014–February 2020); 868 (6.4%) from LEP patients vs 12,722 from EP patients.

"A total of 13 590 eyes were included in the analytic database. Of these, 868 (6.4%) were identified from LEP patients." (Zafar, 2023, p. 596)

Caveats #

• LEP identified only by EMR interpreter-need flag, risking misclassification (Zafar cataract) LEP status was operationalized solely from an electronic-medical-record designation of "needing or preferring an interpreter," recorded by call-center or front-desk staff when the appointment was booked. The authors concede this process may not have accurately captured all LEP patients, and note their observed LEP rate (6.4%) was well below the metro Denver average (8%), suggesting under-ascertainment. Misclassification of the exposure could bias any of the LEP-versus-EP comparisons (mature cataract, complex surgery, preoperative acuity, steroid use, YAG capsulotomy, comorbidity).