Improving Vision with Cataract Surgery Has Another Benefit: Fewer Broken Hips in Elderly

Elderly patients who undergo cataract surgery may be up to 28% less likely to fall and suffer a crippling hip fracture, a new study finds

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It stands to reason that better vision could help people lower their risk of falling and breaking a hip. That’s what a new study of more than a million Medicare patients found: those who had surgery to remove vision-impairing cataracts were significantly less likely to suffer hip fractures afterward, particularly those who were older and very sick.

The finding may impact a wide swath of the population, given that more than half of Americans will develop cataracts by age 80, according to the National Eye Institute. Previous research also finds that cataract surgery not only improves vision, but also boosts elderly patients’ quality of life, allowing them to engage socially and take part in their community more. Without clear vision, people may have trouble performing day-to-day activities or other pursuits, and may be more likely to succumb to low self-esteem and depression.

Hip fractures, too, are a major health concern among the elderly: a study last fall found that elderly women who broke a hip were at least twice as likely to die in the year following injury than uninjured women. Fall-related injuries are pricey as well, costing the U.S. more than $10 billion in 2000.

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Dr. Victoria Tseng and her colleagues at the Warren Alpert Medical School of Brown University looked at a random sample of 1.1 million Medicare beneficiaries aged 65 or older who were diagnosed with cataracts between 2002 and 2009. They compared the rates of hip fractures in 410,809 patients who underwent surgery to remove cataracts with rates in patients who did not. Overall, the researchers found, patients who received cataract surgery were 16% less likely to break a hip in the year after the procedure, but the benefit was most pronounced in older patients.

The oldest patients in the study, those aged 80 to 84, enjoyed the greatest benefits, with 28% fewer fractures. Those with chronic illnesses like heart disease or diabetes were also 26% to 28% less likely to experience a hip fracture after cataract surgery, compared with equally sick patients who didn’t undergo surgery. And patients who had severe cataracts removed had a 23% lower risk of breaking a hip than others who also had severe cataracts but didn’t have surgery.

However, surgery had no impact on fracture risk in younger patients aged 65 to 69. Why? The New York Times reported:

Researchers speculated that the youngest patients having cataract surgery may be very active people who had the surgery in only one eye, which could worsen problems with depth perception and balance, or may include people with serious neurological ailments. They said more study of this age group was needed.

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For frailer, older patients, though, cataract surgery, a commonly performed and generally safe outpatient procedure, may offer a vast range of benefits. “Cataract surgery has already been demonstrated to be a cost-effective intervention for visual improvement,” the authors conclude. “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.

“This is elective surgery, and sometimes people think, ‘I’m too sick to have my cataracts out,’ or ‘I’m too old,’” study author Dr. Anne L. Coleman, a professor of ophthalmology at the Jules Stein Eye Institute at the University of California, Los Angeles, told the Times. “But the take-home message from this study is that if you’re starting to have vision problems and the doctor says you have cataracts, you should probably think of having them removed.”

The study was published in The Journal of the American Medical Association.
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