Geographic Barriers Limit Access to Cataract Surgery

Greater travel distance to a cataract surgeon is linked to significantly lower odds of receiving cataract surgery among California Medicare beneficiaries, with Black and Hispanic/Latino beneficiaries being disproportionately affected, according to a study published in the Journal of Cataract & Refractive Surgery.¹

Every additional 100 miles a beneficiary with cataracts had to travel for surgery was associated with a 14% drop in the odds of receiving it (adjusted odds ratio [aOR], 0.86). The impact was far steeper for Black beneficiaries (62% lower odds; aOR, 0.38) and Hispanic/Latino beneficiaries (33% lower odds; aOR, 0.67) than for White beneficiaries (8% lower odds; aOR, 0.92).

Eyecare Barriers Linked to Travel Time and Distance

Cataract is the leading reversible cause of vision impairment in the US, accounting for about 60% of Medicare vision costs. The number of Americans with cataracts is projected to nearly double by 2050, from 24.4 million to about 50 million. The authors noted that previous studies have shown rural areas have decreased access to cataract surgery.

This cross-sectional study aimed to examine the geographic factors associated with the likelihood of receiving cataract surgery. Using 2017 California Medicare data, the researchers compared travel distance and travel time to cataract surgery between beneficiaries living in rural vs nonrural areas of California. They also examined whether travel distance and time were associated with whether someone received cataract surgery at all and tested whether race and ethnicity modified that relationship.

The study was conducted using the 2017 California Medicare Master Beneficiary Summary File and Part B Carrier Claim files from the CMS. Beneficiary eligibility required residency in California in 2017 (defined by having a valid California zip code for their residential address), being 65 years of age or older, enrollment in Medicare Part A and Part B, at least 1 Part B claim in 2017 to demonstrate active use of benefits, and an International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code for cataract.

Racial Disparities in Eye Care

The study sample consisted of 445,164 beneficiaries with cataracts, of whom 93,460 (21.0%) received surgery. On average, rural beneficiaries traveled 9.7 more miles and 0.16 more hours for cataract surgery than nonrural beneficiaries. Overall, each additional hour of travel time cut the odds of surgery by 6%, and each additional 100 miles cut the odds by 14%.

The racial and ethnic disparities were stark: for every additional 100 miles traveled, White beneficiaries saw an 8% decrease in their odds of receiving surgery (aOR, 0.92), Asian beneficiaries a 19% decrease (aOR, 0.81), Hispanic/Latino beneficiaries a 33% decrease (aOR, 0.67), and Black beneficiaries a 62% decrease (aOR, 0.38). The authors tested for a statistical interaction between travel distance and race and ethnicity and found it highly significant (P < .0001), confirming that distance affects access differently depending on a patient's race or ethnicity.

The authors framed these disparities through a structural lens rather than a biological one, noting that race is a social construct, not a genetic category. This aligns with their finding that ophthalmologists are concentrated in higher-income, urban areas, alongside underinvestment in minoritized and rural communities. In a 2020 interview with The American Journal of Managed Care^® about barriers to eye care, Daniel Laroche, MD, director of Glaucoma Services and president of Advanced Eye Care of New York, described the same structural gap.

"I'll give an example: There are about 41 million Black Americans in the United States, but as an eye surgeon, there are only 400 Black ophthalmologists," said Laroche. "So, there's a huge lack of access to care. The other 26,000 ophthalmologists are dispersed—there's a huge maldistribution problem. Many of them are on the East Coast, on the West Coast, and not as much in the South. Unfortunately, we have a lot of residential segregation, and so many of them don't practice in Black communities, so a lot of Black patients don't have access to specialist care."

Cataract Surgery Study Limitations

The authors noted several limitations. As the study is cross-sectional and relies on claims data, it can identify associations but cannot establish causality between travel distance and surgical outcomes. The sample's racial and ethnic makeup may not fully reflect California's broader older adult population, and the authors pointed to possible selection bias, since Black and Hispanic/Latino Medicare beneficiaries are known to under-enroll in and underutilize Medicare benefits. Distance measurements were also based on zip code–level geocoding, which may underestimate actual travel distance and time. As the analysis is limited to California Medicare beneficiaries 65 years and older, the findings may not generalize to younger patients, those with private insurance, or the uninsured.

The authors called for system-level interventions “modeled after successful implementation in other regions in the United States and globally,” citing specific measures such as subsidized travel, expanded teleophthalmology triage sites, streamlined preoperative testing within the same visit as diagnosis, patient navigator programs to help with transportation and logistics, and greater investment in community hospitals in rural and under-resourced areas. As the authors put it, building out this kind of infrastructure could provide “a foundation…to strive toward equitable access to vital vision care.”

References

1. Murillo K, Kitayama K, Yu F, Tseng VL, Coleman AL. Geographical barriers to surgical treatment for cataract among California Medicare beneficiaries. J Cataract Refract Surg. 2026;52(6):544-550. doi:10.1097/j.jcrs.0000000000001878
2. Gavidia M. Dr Daniel Laroche discusses eye-related implications, barriers to eye care amid COVID-19. AJMC^®. August 1, 2020. Accessed August 18, 2026. https://www.ajmc.com/view/dr-daniel-laroche-discusses-eye-related-implications-barriers-to-eye-care-amid-covid-19