Cataract surgery reduces rate of fractures in older patients with vision loss

Aug 2 2012

A major study of Medicare beneficiaries shows that the risk of hip fractures was significantly reduced in patients who had had cataract surgery, compared to patients who did not undergo the procedure. Published in the August edition of the Journal of the American Medical Association (JAMA) the researchers believe their study is the first to demonstrate that cataract surgery reduces the rate of fractures in older patients with vision loss. This suggests that cataract surgery could be an effective intervention to help prevent fractures and reduce associated morbidity and costs. The American Academy of Ophthalmology and the Jules Stein Eye Institute at the University of California, Los Angeles, collaborated on the study.

The study tracked hip fracture incidence in a cohort of Medicare patients with cataracts from 2002-09. Anne L. Coleman, M.D., Ph.D., the Fran and Ray Stark professor of ophthalmology at the Jules Stein Eye Institute at UCLA and director of the Academy's Hoskins Center for Quality Eye Care, led the research. The medical records of about 400,000 patients who had cataract surgery were analyzed for hip fractures that occurred within one year of cataract surgery. This data was then compared to hip fracture incidence in a matched group of patients who had cataracts, but did not have cataract surgery. Cataract surgery was associated with a 16 percent decrease in patients' adjusted odds of suffering a hip fracture within one year of the procedure.

This is particularly significant because older people's higher risk of falling makes them especially vulnerable to fractures of the hip and other bones. Previous studies have found that vision loss is a major factor in seniors' risk of falling. When visual sharpness and depth perception decline, people also lose their ability to maintain balance, stability and mobility.

"Our study suggests that people should never be regarded as 'too old' to have their cataracts removed," said Dr. Coleman, who also serves as the Academy's secretary for quality of care. "In fact, the greatest reduction in hip fracture risk was in patients who had cataract surgery when they were in their 80s."

Overall, the greatest decrease in hip fracture risk was seen in patients aged 80 to 84 who had cataract surgery. Another notable group was patients with severe cataracts, for whom risk was reduced by 23 percent. Although U.S. health statistics show that women are more susceptible to hip fractures than men, this study found no significant gender-linked differences in fracture risk.

"When older people's vision improves following cataract surgery, they, their families, and society gain from the resulting reductions in suffering and medical costs," said William L. Rich, M.D., a cataract specialist and the Academy's medical director for health policy. "Ophthalmic research continues to demonstrate that cataract surgery is highly successful in terms of patient-reported outcomes such as improved vision and quality of life. The new study provides data on an important ancillary health benefit."

Source: American Academy of Ophthalmology