Cataract Surgery Linked With Fewer Falls, Traumatic Injuries in Older Patients

CHICAGO — Patients who had cataract surgery had a significantly lower risk of multiple types of traumatic injuries often associated with falls, an analysis of an international database showed.

The risk of fall was 11% lower in patients who had surgery versus those who did not, and the risk of hip fracture was 5% lower, consistent with previous studies. The study added to the evidence by showing significantly fewer leg and ankle fractures in surgically treated patients, as well as fewer epidural and subdural hemorrhages.

Given that cataract surgery is a personal decision for patients, the findings may help inform decisions and warrant discussion with patients during the decision-making process, said Caitlin Hackl, a medical student at the University of Texas Medical Branch at Galveston, at the American Academy of Ophthalmology annual meeting.

“We found decreased odds for all of the injuries that we investigated … and we were able to replicate previous findings of decreased falls and hip fractures in these patients,” said Hackl. “Cataract surgery may be a way to control a modifiable risk factor for these injuries.”

“Although cataract surgery is well recognized as a contributor to improving patient quality of life, our study and past studies suggest that beyond what patients may perceive immediately after and shortly following surgery, improvement in quality of life may be imparted by surgery by way of decreasing traumatic injuries associated with morbidity and mortality,” she added. “Very importantly, patients should be aware that even fractures that they may perceive as less severe than hip and vertebral fractures, increase mortality, and surgery may reduce the risk of these injuries.”

Session moderator Thomas Oetting, MD, of the University of Iowa Carver School of Medicine in Iowa City, called the study “an exciting way to look at our world and think beyond our specialty.” Acknowledging lack of familiarity with the TriNetX database used for the analysis, he asked about strengths and limitations of the database.

The global data network comprises deidentified patient information from 220 organizations, including healthcare organizations, drug companies, and contract research organizations, said Hackl. The system allows for multiple types of research, including retrospective cohort studies, treatment comparisons, healthcare utilization, drug safety, and health disparities. The database capability is evolving and recently integrated multivariate analysis.

Among the limitations, TriNetX in ophthalmology, for example, cannot account for ophthalmic care a patient receives outside the participating organizations, creating a potential for misclassification bias, Hackl continued. Reliance on administrative coding is another limitation, and the network lacks the capability to match for all covariates.

Several studies have shown an increased risk of hip and vertebral fractures and falls in patients with cataracts, said Hackl. Cataract surgery has been associated with a decreased risk for the injuries.

Beyond hip and vertebral fracture, other types of fractures have been linked to increased mortality in older patients, she continued. Additionally, intracranial hemorrhage is a potential consequence of falls in older adults and had not been studied in association with cataracts.

Investigators queried the TriNetX network to examine differences in traumatic injury outcomes in patients with age-related cataracts. They identified 496,990 patients who had cataract surgery and 1,592,381 who had age-related cataracts that were not surgically extracted. Propensity matching resulted in two cohorts of 434,687 patients each. Median age of the entire study population was 68.8.

Hackl and colleagues examined the frequency of falls and hip fractures to validate the data network’s ability to assess the previously described association. They also examined the frequency of fracture of the proximal humerus, distal radius, and ankle, as well as subdural and epidural hemorrhage, and compared results for the two cohorts.

Comparisons of patients who had cataract extraction with those who did not resulted in the following odds ratios (ORs):

• Falls: OR 0.89 (P<0.0001)
• Hip fracture: OR 0.95 (P=0.0026)
• Proximal humerus fracture: OR 0.95 (P=0.026)
• Distal radius fracture: OR 0.93 (P=0.0004)
• Ankle fracture: OR 0.93 (P=0.0081)
• Epidural hemorrhage: OR 0.76 (P=0.0048)
• Subdural Hemorrhage: OR 0.88 (P<0.0001)

Hackl noted that some previous studies have shown that second eye surgery is required to reduce the risk of falls, whereas other studies suggest the initial eye surgery reduces fall risk. Additional studies to assess the risk of other types of traumatic injuries in association with cataracts are warranted.

“Because TriNetX doesn’t have specific visual acuity data, we weren’t able to completely control for baseline visual acuity or assess associations between varying acuity levels and outcomes,” she said. “For this reason, future studies quantifying or qualifying the changes in vision associated with cataracts that increase the risk of injury and for which extraction decreases the risk, are necessary.”

Studies also are needed to assess other vision problems — such as hyperopia, myopia, and glare — and associations between surgery and traumatic outcomes, said Hackl.

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