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Safety and Quality of Life Benefits of Cataract Surgery

What is a cataract?

A cataract is a clouding of the natural lens in the eye. It is usually the result of aging which causes proteins in the eye to break down and clump together, affecting the clarity of visual images on the retina. Cataracts also occur as a result of trauma, diabetes, steroid use and previous eye surgery.

How are cataracts treated?

Initially, cataracts can be tolerated by getting stronger glasses to improve vision. However, when the cataract causes significant visual disability, having it surgically removed is the best option. After the cloudy lens is removed, a clear intraocular lens is implanted which then becomes a permanent part of the eye. This implant can either be a standard monofocal lens or the newer option of multifocal lenses or an astigmatism correcting toric lens.

What are the benefits of cataract surgery?

Many outcome studies have demonstrated that cataract surgery not only improves vision but also enhances quality of life. Research is currently accumulating evidence on safety and possible cognitive benefits for elders.

What are the safety benefits of cataract surgery?

Cataract surgery to improve vision has decreased the risk of falling, of hip fractures and of being in a car accident. Perhaps the most striking outcome is that the oldest patients benefited most from cataract removal.

Why is that noteworthy?

Half of all people over 80 fall each year; many of whom are admitted to hospitals and nursing homes. Of those admitted to nursing homes, 40% never return home; 25% die within 12 months.

Following cataract surgery, research study patients experienced 16 – 23% fewer hip fractures than a comparable group who chose not to have cataract surgery (in the same 12 month period).The greatest reduction of hip fractures occurred in patients 80 and older. The group that most needed to benefit from cataract surgery did so. We now have empirical verification from 400,000 Medicare cataract patients confirming what we see in the much smaller populations of our individual and group practices; the benefits of cataract surgery extend far beyond improved vision.

Are there other safety benefits associated with cataract surgery?

Research studies from Australia and the United States found removing cataracts reduced car crashes. The Australian study examined the relationship of cataract surgery and car crashes of 30,000 surgeries over nine years. There were 13%fewer crashes among elderly patients who had cataract surgery with intraocular lens implants compared to cataract patients who chose not to have surgery. The American study demonstrated elderly patients having cataract surgery were involved in half as many wrecks, 4 – 6 years later, compared to elderly cataract patients who declined surgery.

What else is being studied regarding cataract surgery and the elderly?

A study is in progress focusing on the relationship between cataract removal and the life quality improvements in Alzheimer’s patients. Alzheimer’s disease and cataracts are both age-related so it’s not unusual for both conditions to be present in an elderly patient.

Why does this interest medical researchers?

Ophthalmologists believe the improved vision from cataract surgery is directly related to improving the quality of life for Alzheimer’s patients.

What exactly are quality of life improvements?

Cataracts might stop one from looking through magazines or sewing. Following cataract removal and a lens implant, these activities can be resumed. The person is stimulated and mentally engaged. Their mood improves. They interact more. They sleep better and feel better.

A study was conducted at a Paris Hospital of 38 female patients in their 80’s with coexisting mild Alzheimer type dementia and debilitating cataracts. Following cataract surgery, half the patients slept better and were less depressed. 30% increased interaction with their families.

An ongoing study is currently looking at whether cataract surgery will improve perception, independent functioning and quality of life in American patients with Alzheimer’s disease.

How will this information influence ophthalmology?

We will have solid evidence that aside from improving vision, cataract surgery improves social and physical functioning. Elderly patients and their families considering cataract surgery can be advised that the procedure is especially beneficial for older patients; proven to improve the overall quality of their life in addition to restoring their vision.

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