Surgical correction of visual impairment in older adults may be linked to longer survival

Health problems may prevent patients from undergoing cataract surgery.

Issue: March 2014

Older adults who undergo cataract surgery have a significantly lower mortality risk than those who do not, according to a study.

“The observed association between visual impairment correction and improved long-term survival could have been the result of a number of factors, such as an increased ability to attend doctors, take medications accurately, or shop for food and may have reduced the many consequences of visual impairment like falls, fractures and depression,” Jie Jin Wang, MMed, PhD; Paul Mitchell, PhD; and Calvin Sze-un Fong, MBBS, said in an email interview with Ocular Surgery News.

Those who underwent cataract surgery with resultant better vision had persistent improved survival compared with those with persistent visual impairment who did not undergo cataract surgery, they said.

General health conditions and frailty in statistical models were considered, as were patient demographics, socioeconomic factors and medical history.

“Surgical correction of visual impairment could have improved a person’s confidence and quality of life, which might have led to improved social interaction, emotional well-being and optimism, factors that we did not measure but may explain the observed association,” the study authors said.

Study method

The analysis, published in Ophthalmology, included 354 subjects from the population-based Blue Mountains Eye Study; 184 subjects had both cataract and visual impairment and 170 subjects underwent cataract surgery with no residual visual impairment before baseline examinations. All subjects underwent follow-up examinations at 5 years and 10 years.

Significantly lower long-term mortality risk was evident in subjects who underwent surgical cataract correction before baseline examination or during follow-up without residual impairment compared with those with visual impairment who had not undergone cataract surgery before the baseline or during the follow-up period.

“These findings send the message to patients and ophthalmologists that cataract surgery has benefits beyond the eye and vision,” Wang and colleagues said. “We would like to re-emphasize that our study findings cannot be interpreted as a direct or causal association between visual impairment and higher mortality or between no visual impairment and better survival.”

New evidence

In a report from the Australian Prospective Cataract Surgery and Age-related Macular Degeneration Study, Wang and colleagues were able to address the issue that underlying health problems may have prevented participants from undergoing cataract surgery and contributed to the poor survival rates among the participants in the Blue Mountains Eye Study who did not undergo surgery. The new report from a cohort study of older cataract surgical patients was published in the American Journal of Ophthalmology. The authors compared cataract surgical patients who had corrected and those who had persistent visual impairment, and found similar findings to their previous report from the Blue Mountains Eye Study cohort.

“Our study reinforces the strong message from many previous studies that have documented an association between visual impairment and high mortality risk in older persons by providing new evidence supporting a reverse association between surgical correction of visual impairment and improved long-term survival in older persons,” Wang and colleagues said. – by Christi Fox

References:

Fong CS, et al. Am J Ophthalmol. 2014;doi: 10.1016/j.ajo.2013.08.018.
Fong CS, et al. Ophthalmology. 2013;doi: 10.1016/j.ophtha.2013.02.009.

For more information:

Calvin Sze-un Fong, MBBS, and Paul Mitchell, MD, PhD, can be reached at Clinical Ophthalmology and Eye Health, Westmead Clinical School, C24- Westmead Hospital, NSW 2006 Australia; email: szeun@yahoo.com and paul.mitchell@ sydney.edu.au.
Jie Jin Wang, MMed, PhD, can be reached at the Centre for Vision Research, Westmead Millennium Institute (University of Sydney), Westmead Hospital, Hawkesbury Road, Westmead, NSW Australia, 2145; email: jiejin.wang@sydney.edu.au.
Disclosures: Fong has received a travel fellowship grant from the Centre for Eye Research Australia. Mitchell is a consultant for Novartis and Bayer. Wang receives funding from a National Health and Medical Research Council Senior Research Fellowship.