Cataract Surgery May Help Prevent Hip Fractures Having Surgery to Correct Cataracts May Protect Against Hip

Fractures in Older People

By Jennifer Warner WebMD Health News Reviewed by Louise Chang, MD

July 31, 2012 -- Helping older people see more clearly may help to lower their risk for falls and potentially disabling hip fractures. A new study shows having surgery to correct cataracts may reduce the risk of hip fractures among elderly people by up to 23%. Falls and the resulting bone fractures are a major cause of disability and death among the elderly. Researchers say fall-related injuries cost the U.S. more than $10 billion in health care costs in 2000. The results suggest cataract surgery may be a cost-effective way to reduce the risk of falls and hip fractures among older adults. "Cataract surgery has already been demonstrated to be a cost-effective intervention for visual improvement," researcher Victoria Tseng, MD, of Brown University, and colleagues write in the Journal of the American Medical Association. "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." Study Details Researchers say vision impairment is a known risk factor for falls, especially among the elderly. But few studies have looked at the effect of cataract surgery on the risk of falls and hip fractures among visually impaired older adults. Cataracts are a clouding of the lens in the eye, which blurs the vision. Most cataracts are related to aging, and more than half of all Americans develop cataracts by age 80. Cataract surgery corrects the condition by replacing the clouded lens with a clear artificial one. In the study, researchers looked at the risk of hip fracture within one year, with or without cataract surgery, among more than 1 million people on Medicare aged 65 and older who were diagnosed with cataract between 2002 and 2009. Of these, more than a third (36.9%) had cataract surgery during the study period. Overall, 1.3% or 13,976 people had a hip fracture during the study. Although this type of study cannot prove cause and effect, the association between the surgery and hip fracture was significant. Researchers found people who had cataract surgery had a 16% lower risk 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 researchers write.

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Cataract Surgery is a common procedure done in elderly patients. Cataract surgery is the removal of the lens inside the eye after it has become cloudy due to aging, an eye injury or other causes. In most cases, the cataract surgeon replaces the cloudy natural lens with an artificial lens implant (also called an intraocular lens, or IOL) to restore vision and eliminate the need for thick glasses after surgery. Cataract surgery is one of the most frequently performed surgical procedures in the United States and throughout the world. According to Bausch & Lomb, a leading American eyecare company, more than three million cataract surgeries are performed in the U.S. every year, and more than 50 percent of Americans over age 65 have cataracts in one or both eyes. Hidden among the 85 million people and the 7100 islands of the Philippines, are an estimated half a million people who are blind, and many more who are visually impaired to a lesser degree. By far, the leading cause of blindness among adults in the Philippines is cataract, accounting for around 400,000 cases. The treatment for cataract is simple and effective but is not readily available or affordable for those living in the rural areas. The second national survey of blindness was conducted from April 1994 to June 1995. It covered 76 provinces and 17 municipalities in Metro Manila represented by a total of 155 barangays or villages. A total of 19,449 persons consisting of 46% males and 54% females were examined. The survey showed that the prevalence of bilateral blindness in Filipinos is 0.70% meaning 478,968 out of 68.4 million Filipinos are blind by WHO definition of inability to count fingers at 3 meters. This represents only a decrease by 35% from the 642,000 estimated blind during the first national survey in 1987 when the prevalence rate was 1.07% in a population of 60 million. Cataract (77% of blind), glaucoma and uncorrected aphakia were the most common causes of blindness found during this second national survey. Monocular blindness affects 1.09% of the population (700,000 Filipinos). Cataract is the most common cause. In addition, eye diseases traceable to industrialization are significantly causing a lot of monocular blindness. Within eight years from the first survey, the Prevention of Blindness Program of the Department of Health was launched, the biggest component of which is the cataract backlog eradication program. A Cataract Backlog Project (Oplan Sagip Mata) has been on-going for the past two years. The goal of a national prevalence rate of 0.5% or less by year 2000 seems attainable in spite of the huge cataract backlog if efforts towards its eradication are strengthened. According to Sarah Guy, MedWire Reporter, in her article Cataract surgery reduces hip fracture, as well as improving eye sight Surgery for cataract removal significantly reduces the rate of hip fracture in the year after the procedure compared with no surgery, show study results involving over a million Medicare beneficiaries aged over 65 years. "Visual impairment has been found to be strongly associated with an increased risk of fractures," explain Anne Coleman (University of California at Los Angeles, USA) and co-workers, adding that vision plays a role in postural balance and stability, which is often lost in individuals with cataracts."Furthermore, cataracts have been found to be the most common cause of fracture-related visual impairment," writes the team in JAMA. In a random sample of 1,113,640 Medicare beneficiaries identified between 2002 and 2010 with a diagnosis code indicating cataracts and aged at least 65 years, 410,809 (36.9%) underwent surgery for their condition. Coleman and colleagues compared the incidence of hip fracture and any fracture in these and the 702,831 (63.1%) cataract patients not treated surgically either in the year of treatment, or the year of diagnosis.Overall, the authors report a respective 1.3% and 5.4% hip and any fracture rate during the study period. After adjustment for factors including age, race, gender, area of residence in the USA, and comorbidities and physically limiting conditions, patients who received cataract surgery were a significant 16% less likely to experience hip fracture than their nonsurgically treated peers.

This association was even stronger in patients with severe cataracts (including anterior and posterior subcapsular cataracts, total, mature and hypermature cataracts, and combined forms of cataract) who had a 23% reduction in odds for hip fracture in the year after surgery. "Cataract surgery has already been demonstrated to be a cost-effective intervention for visual improvement," note Coleman et al, who add that their results suggest further potential benefits of this procedure to decrease the incidence of fractures in the elderly.Indeed, adjusted analysis showed that the risk for any fracture was a significant 5% and 8% less among surgery patients with cataract and severe cataract, respectively, compared with their peers with a diagnosis alone."Future prospective studies using standardized registries of patients with cataracts will help further elucidate the association between cataract surgery and fracture risk," Coleman and colleagues conclude. This article was also supported by Denise Mann a HealthDay Reporter in her journal titled Cataract Surgery May Cut Risk of Hip Fracture, In the new study, individuals aged 65 or older who had cataract surgery were less likely to sustain a hip fracture within a year of the procedure when compared with their peers who did not have the surgery. Researchers analyzed Medicare claims data, but they did not have access to information on falls.Their findings appear in the Aug. 1 issue of the Journal of the American Medical Association. Reduction in risk for hip fractures may help tip the scale in favor of cataract surgery, said study author Dr. Anne Coleman, professor of ophthalmology at the Jules Stein Eye Institute at the University of California, Los Angeles. "Hip fracture is associated with decreased quality of life and increased risk of dying," Coleman said. "You are never too old or too ill to consider cataract surgery to improve vision and quality of life and decrease your risk of hip fracture.""The risks are there, but they are very low," Coleman said. They may include inflammation, infection, bleeding and swelling. After surgery, patients "get to enjoy more of the visual world in terms of colors and contrasts, and they can recognize their friends." The study included a 5 percent random sample of Medicare beneficiaries from 2002 to 2009 who had cataracts. Of the more than 1.1 million patients with cataracts, 36.9 percent had surgery during the study period.Overall, 1.3 percent of this population sustained a hip fracture. Those who had cataract surgery were 16 percent less likely to sustain a hip fracture in the year after the surgery. This association was even more pronounced among people with severe cataracts, the study showed."This really does make complete sense and documents nicely what we have always said: Any improvement in vision that can be accomplished easily in an elderly patient would be expected to reduce the risk of falling and therefore of fractures -- especially hip fractures," said Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York City.It is for these reasons that "we like to assure that homes are lighted properly, that night lights be used for nocturnal trips to the bathroom, that barriers that might cause trips or falls be eliminated or at least easily seen, that vision be corrected with corrective lenses," she said. "If cataracts are impacting vision and surgery is indicated, the results would likely reduce fall risk and therefore fracture risk."The study did not have information on falls, Siris said.

"It does remain possible that people who opt for surgery are somewhat different from those who don't, and that in itself could explain the reduction in fractures," she said. For example, these patients may be more likely to have assistance in their daily lives and better quality lives with a lower risk of falls to begin with. "Some people wait much too long for cataract surgery, and this puts the elderly at risk for a hip fracture or falling," said Dr. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City. "The better you see, the better you ambulate."The time for surgery is when the cataract starts limiting what you can do."Elderly people are more fragile, so if they don't see a step or an elevation and trip, that could be a death sentence," Fromer said. "Cataract surgery takes less than 10 minutes and can dramatically alter a person's lifestyle." The study only showed an association -- not a cause-and-effect relationship -- between cataract surgery and a reduced risk of fall-related hip fractures.

REFERENCE:

http://www.webmd.com/eye-health/news/20120731/cataract-surgery-may-help-prevent-hipfractures http://news.yahoo.com/cataract-surgery-may-cut-risk-hip-fracture-200513324.html http://www.lasiksurgerynews.com/news/cataract-surgery.shtml http://www.news-medical.net/news/20120803/Cataract-surgery-reduces-hip-fracture-as-wellas-improving-eye-sight.aspx

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