Linking multicenter electronic health records with socioeconomic data to examine receipt of standard versus premium intraocular lenses

Purpose: Premium intraocular lenses (IOLs) can improve visual outcomes and reduce dependence on glasses but often require out-of-pocket payment. The socioeconomic factors influencing their selection remain poorly understood. Leveraging a multi-institutional electronic health record dataset, we examined demographic and socioeconomic factors associated with receiving a premium versus standard IOL and the likelihood of switching IOL type (premium to standard or vice versa) between first and second cataract surgeries. Design: Retrospective cohort study across 10 medical centers. Participants: 46,349 patients who underwent cataract surgery with IOL implantation from 2010 to 2023. Results: 9.7 % of patients received at least one premium intraocular lens (IOL). Toric lenses comprised 79 % of premium implants. Premium IOL recipients were more often White, English-speaking, higher income, and college educated. Black race (aOR 0.44, 95 % CI 0.30–0.66), non-English language (aOR 0.64, 95 % CI 0.44–0.94), lower income (aOR 0.40, 95 % CI 0.20–0.81), and lower education were associated with reduced odds of premium IOL implantation. Associations persisted after accounting for ocular comorbidities. Among bilateral cases, 4.2 % of patients switched IOL type between surgeries. Specifically, Black and lower-income patients were less likely to upgrade to a premium IOL for their second surgery. Conclusions: Socioeconomic and racial factors are strongly associated with the choice of premium IOL, with toric lenses comprising the majority of premium implants. Targeted efforts to improve access and patient education may help ensure more equitable adoption of advanced lens technologies.