A study published in the August 1 edition of JAMA reveals that Medicare patients aged 65 years and older who had cataract surgery had a lower risk of hip fracture one year after their eye surgery compared with those who had no cataract surgery.

The study indicates that amongst elderly people, visual impairment is strongly linked to an elevated risk of fractures, and a considerable cause of illness and death. Background information in the study states:

“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. Furthermore, cataracts have been found to be the most common cause of fracture-related visual impairment, with untreated cataract causing up to 49 percent of visual impairment in patients with femoral neck fractures related to decreased vision.”

Only few studies have evaluated the impact of cataract surgery on falling incidences in visually impaired adults, even though there is a strong evident link between these two factors.

Victoria L. Tseng, M.D., of the Warren Alpert Medical School of Brown University, Providence, R.I., and her team evaluated the link between cataract surgery and fracture incidence at 1-year by reviewing a 5% random sample of Medicare Part B beneficiaries, i.e. a total of 1,113,640 Medicare beneficiaries with cataract who did and did not receive cataract surgery between 2002 and 2009. Most of the patients in the sample were female (60%) and white (88%). Findings were adjusted for various variables.

410,809 or 36.9% of the cataract patients had eye surgery during the study period and the overall number of 13,976 patients sustained a fracture during the 1-year period, which translates to a fracture incidence of 1.3%. The findings revealed that cataract surgery was linked to a 16% reduced risk of sustaining a hip fracture 1 year after the procedure. The authors comment: “In patients with severe cataract, the association between cataract surgery and lower odds of hip fracture was even stronger, with a 23 percent reduction in the adjusted odds of hip fracture in the cataract surgery group compared with the cataract diagnosis group.”

The most frequent fracture-related comorbidity was osteoporosis with 12.1% and the most common ocular comorbidity was glaucoma with 19.1%.

The researchers conclude:

“Cataract surgery may be associated with lower odds of subsequent fracture in patients aged 65 years and older in the U.S. Medicare population. Future prospective studies using standardized registries of patients with cataracts will help further elucidate the association between cataract surgery and fracture risk.

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.”

Written by Petra Rattue