06 August 2012
Improved Vision After Cataract Surgery Lowers Risk of Broken Hips
from The New York Times, August 1, 2012
By RONI CARYN RABIN
Older people who have eye surgery to remove cataracts and improve their vision also significantly reduce their risk of breaking a hip in a fall, with the sickest among them and those in their early 80s experiencing nearly 30 percent fewer hip fractures in the first year, a large study reports.
The study adds to findings from earlier papers indicating that the benefits of cataract surgery, a relatively safe outpatient procedure with a high success rate, may significantly enhance the quality of life for the elderly, improving sleep, enabling them to be more engaged and mentally alert and curbing depression.
“This is elective surgery, and sometimes people think, ‘I’m too sick to have my cataracts out,’ or ‘I’m too old,’ ” said Dr. Anne L. Coleman, the study’s lead author and a professor of ophthalmology at the Jules Stein Eye Institute at the University of California, Los Angeles. “But the take-home message from this study is that if you’re starting to have vision problems and the doctor says you have cataracts, you should probably think of having them removed.”
Hip fractures, which become more common with age, are serious injuries for elderly people, with complications that can be life-threatening.
The new study, published on Tuesday in The Journal of the American Medical Association, examined the incidence of hip fractures within a year of cataract surgery in a random sample of 1.1 million Medicare beneficiaries age 65 and older who were given a cataract diagnosis from 2002 to 2009.
The study compared the incidence of hip fracture among 410,809 patients who had surgery to remove the cataracts during the study period with the incidence among those who did not, adjusting for differences in age, race, sex, place of residence, cataract severity and other illnesses and physically limiting conditions.
Some 13,976 of the patients sustained hip fractures in the course of a year.
Those who had cataracts removed sustained 16 percent fewer hip fractures in the year after surgery than those who did not, the study found, though the youngest patients — those ages 65 to 69 — did not reap this benefit, and in fact experienced an increase in hip fractures.
Researchers speculated that the youngest patients having cataract surgery may be very active people who had the surgery in only one eye, which could worsen problems with depth perception and balance, or may include people with serious neurological ailments. They said more study of this age group was needed.
But older patients and those who were very ill benefited tremendously. Patients ages 80 to 84 experienced the most significant benefit, with 28 percent fewer hip fractures. Those who had many other illnesses and chronic conditions, like heart disease, were 26 to 28 percent less likely to experience a fracture than equally sick patients who did not have the cataracts removed.
And those who had severe cataracts removed experienced 23 percent fewer hip fractures than those who had severe cataracts but did not have surgery.
“Seeing helps you navigate a new environment and helps with balance,” Dr. Coleman said. “You really need your eyes and vision to help you stay stable.”
Kavita Sivaramakrishnan, an assistant professor at the Mailman School of Public Health at Columbia University who was not involved in the research, called the findings “exciting” and said they underscore the critical role that vision plays in quality of life and healthy aging.
“Visual functioning helps in so many ways, whether it’s nighttime driving, participating in community activities or mental health,” she said. “People will tell you their life satisfaction is so much higher after cataract surgery.” Poor vision “affects your self-confidence so much,” she added.
Dr. Coleman, an eye surgeon who studies the effect of visual impairment on falls and fractures, described an elderly breast cancer patient whom she had treated. The patient suffered from severe cataracts, and her adult daughters led her around on a leash.
“Her internist asked me to take out her cataracts even though she was very ill with the cancer,” she recalled. “After the first cataract was removed, she came back and walked into the exam room on her own, not being led on a leash. She was excited, she had on makeup, she was dressed nicely and she walked in with authority. She told her daughters to wait in the waiting room. She was back in control.”