BACKGROUND AND PURPOSE:

• Previous studies have found an association between cataract surgery and mortality risk
• These studies did not look at mortality outcome with respect to different medical disorders
• There are sex differences related to eye health
  • Approximately 7% more women are blind and 33% more are vision-impaired vs men
• Tseng et al. (JAMA Ophthalmology, 2018) examined the possible associated between cataract surgery and total and cause-specific mortality in older women with cataracts using the WHI database

METHODS:

• Prospective cohort study
• WHI database
  • US postmenopausal women aged 50 to 79 years
  • 4 overlapping RCTs that assessed hormone therapy, diet modification, and calcium and vitamin D supplementation (68,132 women) and observational study cohort (93,676 women)
• Participants in experimental group: Patients were at least 65 years old with ICD9 and CPT coding for cataracts
• Primary outcomes
  • All-cause mortality and mortality attributed to vascular, cancer, accidental, neurologic, pulmonary, and infectious causes

RESULTS:

• Study cohort: 74,044 women with cataract
  • 41,735 were in the cataract surgery group and 32,309 were in the cataract diagnosis group
  • Mean (SD) age was 70.5 (4.6) years
• In covariate-adjusted Cox models, cataract surgery was associated with lower all-cause mortality
  • Adjusted hazard ratio [AHR] 0.40 (95% CI, 0.39-0.42)
• Cataract surgery was associated with lower mortality specific to the following diseases
  • Vascular (AHR, 0.42; 95% CI, 0.39-0.46)
  • Cancer (AHR, 0.31; 95% CI, 0.29-0.34)
  • Accidental (AHR, 0.44; 95% CI, 0.33-0.58)
  • Neurologic (AHR, 0.43; 95% CI, 0.36-0.53)
  • Pulmonary (AHR, 0.63; 95% CI, 0.52-0.78)
  • Infectious (AHR, 0.44; 95% CI, 0.36-0.54)

CONCLUSION:

• Adjusting for confounders, cataract surgery was associated with a 60% reduction in overall mortality, and 37% to 69% reduction in mortality due to other disorders, including pulmonary disease and cancer
• Further study is needed to assess the underlying mechanism to explain these results
• Regardless of mechanism, this study demonstrates the importance of access to cataract surgery for older women

Learn More – Primary Sources:

Association of Cataract Surgery With Mortality in Older Women

Invited Commentary: Association of Cataract Surgery With Decreased Mortality Among US Women

Related ObG Topics:

The WHI Randomized Trials: Is Menopausal Hormone Therapy Associated with Long-Term Mortality?

North American Menopause Society: Hormone Therapy Statement