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#Grand Rounds

Is Cataract Surgery in Women Associated with Decreased Mortality?

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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

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Related ObG Topics:

The WHI Randomized Trials: Is Menopausal Hormone Therapy Associated with Long-Term Mortality?
North American Menopause Society: Hormone Therapy Statement

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