JAMA Ophthalmology, January 2018
Cataract surgery has been shown to correlate with lower risk of all-cause mortality, potentially because of improved health status and functional independence; however, the association between cataract surgery and cause-specific mortality had not been investigated. To this end, Tseng et al. aimed to determine the relationship between cataract surgery and total and cause-specific mortality in older women. Results of their study indicate that this surgery may lower the mortality risk associated with systemic illnesses.
The study included nationwide data of the Women’s Health Initiative (WHI), from July 2014 through September 2017, for women ≥ 65 years of age who had cataract. Cataract surgery was determined by Medicare claim codes. Outcomes of interest were all-cause mortality and mortality attributed to cancer, vascular, accidental, neurologic, pulmonary, and infectious causes.
The log-rank test and Cox regression models were used to compare mortality data for patients who did and did not undergo cataract surgery, with adjustments made for demographics, smoking status, alcohol use, body mass index, physical activity, and systemic and ocular comorbidities.
Of the 74,044 women with cataract (mean age, 70.5 years), 41,735 underwent cataract surgery. The crude incidence of all-cause mortality was 1.52 per 100 person-years in the cataract surgery group and 2.56 per 100 person-years in the cataract diagnosis group. Covariate-adjusted Cox models showed a link between cataract surgery and reduced all-cause mortality (adjusted hazards ratio [AHR], 0.40) and between cataract surgery and mortality related to cancer (AHR, 0.31), vascular (AHR, 0.42), accidental (AHR, 0.44), neurologic (AHR, 0.43), pulmonary (AHR, 0.63), and infectious (AHR, 0.44) diseases.
It is unclear whether the favorable associations relate directly to cataract surgery. Patients who underwent the surgery had a much lower mortality rate, despite their overall sicker systemic profile. The authors hypothesize that the mechanism of association is multifactorial and can vary by systemic condition. Whether a patient receives cataract surgery depends on demographic, socioeconomic, and other factors, which warrant exploration. Further study of the relationship between cataract surgery, systemic disease, and disease-related mortality may improve patient care and overall health outcomes. (Also see related commentary by Justine R. Smith, FRANZCO, PhD, in the same issue.)
The original article can be found here.