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  • Cataract Surgery May Provide Long-Term Protective Cognitive Benefits

    Cataract/Anterior Segment, Comprehensive Ophthalmology

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    Review of: Cataract surgery and cognitive benefits in the older person: A systematic review and meta-analysis

    Yeo B, Ong R, Ganasekar P, et al. Ophthalmology, in press 2024

    Pooled data from 24 published studies, involving more than 558,000 older participants, indicate that those who had cataracts and underwent surgery appeared to have a lower risk of developing cognitive decline than those with unoperated cataracts and a similar risk to those without cataracts.

    Study Design

    This was a systematic review and meta-analysis of articles published before September 2022 which examined the role of cataract surgery in preventing or slowing long-term cognitive decline (cognitive impairment and dementia). The diagnosis of dementia was based on clinical criteria, including those developed by International Classification of Disease (ICD) Codes and the Diagnostic and Statistical Classification of Mental Disorders, while cognitive impairment was based on screening questionnaires, common cognitive tests such as the Mini-Mental State Examination, and/or clinical diagnostic criteria.

    Outcomes

    Patients who underwent cataract surgery had an overall 25% reduced risk in long-term incidence of cognitive decline compared with patients with unoperated cataracts (pooled ratio of means [RoM] 0.75) and a similar risk to that of healthy controls with no cataracts (hazard ratio 0.84). Interestingly, for patients who had preexisting cognitive impairment, cataract surgery was not associated with improvement in short-term cognitive test scores (RoM 0.98).

    Limitations

    Since this was a meta-analysis incorporating many different studies, there was no standardized method of pre- and postsurgical cognitive testing. There were also no controls for other variables, such as genetic predisposition, comorbid intraocular diseases that affect visual acuity, and environmental/social factors.

    Clinical Significance

    These findings provide preliminary evidence for considering the cognitive benefits of cataract surgery for older patients. Additional studies which standardize pre- and post–cataract surgery cognitive testing would be useful.

    Financial Disclosures: Dr. Stella Luo discloses no financial relationships.