Cataract Surgery May Cut Risk of Hip Fracture

Study found seniors who had procedure were less likely to have fall-related breaks

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Tuesday, July 31, 2012

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TUESDAY, July 31 (HealthDay News) -- Cataract surgery may help some senior citizens reduce their risk of fall-related hip fractures, a new study suggests.
A cataract is a clouding of the eye's lens; symptoms can include blurry vision, glare and poor night vision. As a result, people with cataracts may be more prone to falls.
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."
During cataract surgery, the lens of the eye is removed and replaced with an artificial one.
"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.

SOURCES: Ethel Siris, M.D., Madeline Stabile Professor of Clinical Medicine, and director, Toni Stabile Osteoporosis Center, Columbia University Medical Center, New York City; Anne Coleman, M.D., Ph.D., Fran and Ray Stark Foundation Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles; Mark Fromer, M.D., ophthalmologist, Lenox Hill Hospital, New York City

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