Medicare patients aged 65 and older who underwent cataract surgery had a lower risk of hip fracture one year after the procedure when compared with patients with cataracts who did not have cataract surgery, according to a study published in The Journal of the American Medical Association.
Visual impairment has been found to be strongly associated with an increased risk of fractures, a significant cause of illness and death in the elderly population. “Specifically, vision plays an important role in providing a reference frame for postural balance and stability, and cataract-induced changes in vision have been found to be associated with postural instability,” according to background information in the article.
“Furthermore, cataracts have been found to be the most common cause of fracture-related visual impairment, with untreated cataract causing up to 49% of visual impairment in patients with femoral neck fractures related to decreased vision.” Despite the association of poor vision and cataracts with increased fall and fracture risk, only a limited number of studies have examined the influence of cataract surgery on fall incidence in visually impaired adults.
Victoria L. Tseng, MD, of the Warren Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues examined the association between cataract surgery and fracture incidence at one year. The study included a 5% random sample of Medicare Part B beneficiaries with cataracts who received or did not receive cataract surgery from 2002 through 2009. Analyses were adjusted for various factors.
There were 1,113,640 Medicare beneficiaries aged 65 and older with a diagnosis of cataracts between 2002 and 2009 in the random sample. Of these patients, the majority were female (60%) and white (88%). Of patients with cataracts, 410,809 (36.9%) underwent cataract surgery during the study period. During this period, the overall one-year fracture incidence was 1.3% (n = 13,976) for hip fractures. Analysis of the data indicated that cataract surgery was associated with a 16% decrease in the adjusted odds of hip fracture one year after the procedure.
“In patients with severe cataract, the association between cataract surgery and lower odds of hip fracture was even stronger, with a 23% reduction in the adjusted odds of hip fracture in the cataract surgery group compared with the cataract diagnosis group,” the authors wrote.
Osteoporosis was the most common fracture-related comorbidity (12.1%), and glaucoma was the most common ocular comorbidity (19.1%).
“Cataract surgery may be associated with lower odds of subsequent fracture in patients aged 65 and older in the US Medicare population. Future prospective studies using standardized registries of patients with cataracts will help further elucidate the association between cataract surgery and fracture risk,” the researchers concluded.
Cataract surgery has already been demonstrated to be a cost-effective intervention for visual improvement, with an estimated cost per quality-adjusted life year gained for cataract surgery in the first eye of $2,023 in the United States and $2,727 in the second eye. The results in this study suggest the need for further investigation of the additional potential benefit of cataract surgery as a cost-effective intervention to decrease the incidence of fractures in the elderly.
— Source: The Journal of the American Medical Association
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