Karen Fernandez

All Publications

• The Impact of Race and Ethnicity on Cataract Surgery in the Nationwide All of Us Cohort. Ophthalmic epidemiology Fernandez, K. S., Ravindranath, R., Wang, S. Y. 2025: 1-9

  Abstract

  Cataracts are a leading cause of blindness treatable with surgery. The purpose of this retrospective study was to investigate the association between cataract surgery and race/ethnicity, socioeconomic status, healthcare access, and other factors related to social determinants of health.A total of 37,204 participants with at least one cataract diagnosis were included in this study from the All of Us Research Program using electronic health records and self-reported surveys. Kaplan-Meier and Cox models assessed risk factors for cataract surgery, while summary statistics showed surgery rates by age, race, and gender. The primary outcome was cataract surgery, identified by Current Procedural Terminology (CPT) codes.Of the included participants, 19.8% (N = 7,363) underwent cataract surgery. The overall cataract surgery rate for this cohort was 30.6 per 1000 person-years and was significantly higher for persons who were 70-79 years old (58.5 per 100 persons-years), male (31.8 per 1000 person-years), or Hispanic (39.0 per 100 person-years). Non-Hispanic Black participants had the lowest cataract surgery rate (24.4 per 1000 person-years). Cox models demonstrated an increased hazard of undergoing cataract surgery among Hispanic participants (adjusted HR 1.31; 95% CI [1.21, 1.42]) compared to non-Hispanic White participants. A decreased hazard for undergoing cataract surgery was observed for non-Hispanic Black participants (adjusted HR 0.88, 95% CI [0.81,0.95]) compared to non-Hispanic White participants.Age, race/ethnicity, and sex were significantly associated with time from cataract diagnosis to first cataract surgery. These findings highlight barriers and disparities in cataract surgery, emphasizing the need for interventions to promote health equity.

  View details for DOI 10.1080/09286586.2025.2500017

  View details for PubMedID 40329612

• Big data and electronic health records for glaucoma research. Taiwan journal of ophthalmology Bernstein, I. A., Fernandez, K. S., Stein, J. D., Pershing, S., Wang, S. Y. 2024; 14 (3): 352-359

  Abstract

  The digitization of health records through electronic health records (EHRs) has transformed the landscape of ophthalmic research, particularly in the study of glaucoma. EHRs offer a wealth of structured and unstructured data, allowing for comprehensive analyses of patient characteristics, treatment histories, and outcomes. This review comprehensively discusses different EHR data sources, their strengths, limitations, and applicability towards glaucoma research. Institutional EHR repositories provide detailed multimodal clinical data, enabling in-depth investigations into conditions such as glaucoma and facilitating the development of artificial intelligence applications. Multicenter initiatives such as the Sight Outcomes Research Collaborative and the Intelligent Research In Sight registry offer larger, more diverse datasets, enhancing the generalizability of findings and supporting large-scale studies on glaucoma epidemiology, treatment outcomes, and practice patterns. The All of Us Research Program, with a special emphasis on diversity and inclusivity, presents a unique opportunity for glaucoma research by including underrepresented populations and offering comprehensive health data even beyond the EHR. Challenges persist, such as data access restrictions and standardization issues, but may be addressed through continued collaborative efforts between researchers, institutions, and regulatory bodies. Standardized data formats and improved data linkage methods, especially for ophthalmic imaging and testing, would further enhance the utility of EHR datasets for ophthalmic research, ultimately advancing our understanding and treatment of glaucoma and other ocular diseases on a global scale.

  View details for DOI 10.4103/tjo.TJO-D-24-00055

  View details for PubMedID 39430348

  View details for PubMedCentralID PMC11488813

• Factors Associated with Cataract Surgery in the Nationwide All Of Us Cohort Fernandez, K., Ravindranath, R., Wang, S. Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316201206

• Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening. JAMA ophthalmology Ravindranath, R., Bernstein, I. A., Fernandez, K. S., Ludwig, C. A., Wang, S. Y. 2023

  Abstract

  Regular screening for diabetic retinopathy often is crucial for the health of patients with diabetes. However, many factors may be barriers to regular screening and associated with disparities in screening rates.To evaluate the associations between visiting an eye care practitioner for diabetic retinopathy screening and factors related to overall health and social determinants of health, including socioeconomic status and health care access and utilization.This retrospective cross-sectional study included adults aged 18 years or older with type 2 diabetes who answered survey questions in the All of Us Research Program, a national multicenter cohort of patients contributing electronic health records and survey data, who were enrolled from May 1, 2018, to July 1, 2022.The associations between visiting an eye care practitioner and (1) demographic and socioeconomic factors and (2) responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys were investigated using univariable and multivariable logistic regressions.The primary outcome was whether patients self-reported visiting an eye care practitioner in the past 12 months. The associations between visiting an eye care practitioner and demographic and socioeconomic factors and responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys in All of Us were investigated using univariable and multivariable logistic regression.Of the 11 551 included participants (54.55% cisgender women; mean [SD] age, 64.71 [11.82] years), 7983 (69.11%) self-reported visiting an eye care practitioner in the past year. Individuals who thought practitioner concordance was somewhat or very important were less likely to have seen an eye care practitioner (somewhat important: adjusted odds ratio [AOR], 0.83 [95% CI, 0.74-0.93]; very important: AOR, 0.85 [95% CI, 0.76-0.95]). Compared with financially stable participants, individuals with food or housing insecurity were less likely to visit an eye care practitioner (food insecurity: AOR, 0.75 [95% CI, 0.61-0.91]; housing insecurity: AOR, 0.86 [95% CI, 0.75-0.98]). Individuals who reported fair mental health were less likely to visit an eye care practitioner than were those who reported good mental health (AOR, 0.84; 95% CI, 0.74-0.96).This study found that food insecurity, housing insecurity, mental health concerns, and the perceived importance of practitioner concordance were associated with a lower likelihood of receiving eye care. Such findings highlight the self-reported barriers to seeking care and the importance of taking steps to promote health equity.

  View details for DOI 10.1001/jamaophthalmol.2023.5287

  View details for PubMedID 37971726