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Fall risk may rise after cataract surgery

NEW YORK (Reuters Health) – Contrary to some past research, a new study finds that elderly adults who have cataract surgery could face an increased risk of falls and fractures in the next year — at least if they have only one eye done.

The increase was seen mostly in patients age 80 and up, and researchers say it’s not clear what factors — related to the surgery or not — might explain the added risk.

In the new study, researchers looked at records for more than 15,000 Australian adults who’d had a first-time cataract surgery.

Overall, 600 were hospitalized for a fall-related hip fracture or other injury — either during the year before or the year after the eye surgery. And the risk, it turned out, was greater in the year after.

There were 273 hospitalizations in the year before surgery, and 352 in the year after.

When the researchers adjusted for other factors, the risk of hospitalization was 27% higher in the year after cataract surgery.

The findings, reported August 6 in the Journal of the American Geriatrics Society, conflict with a U.S. study published just last month.

That study reviewed Medicare records for one million older Americans with cataracts. It found that those who had cataract surgery had a somewhat lower risk of breaking a bone in the following year, versus those who did not have surgery.

But there are differences in the study groups that may help explain the conflicting findings, according to Dr. Lynn B. Meuleners, of Curtin University in Perth, Australia, who led the new study.

For one, she said in an email, her study looked at patients who’d had cataract surgery in only the first eye. In Western Australia, where the study was done, people typically wait six months to a year to have their second eye treated, if needed.

Dr. Meuleners suspects that may be a factor in the higher fall risk after surgery. If people had “lopsided vision” after single-eye surgery, that might have made them more prone to falls.

“It may also have been due to wearing old glasses and having poor vision in the corrected eye because of the glasses, and poor vision in the other eye due to cataract,” Dr. Meuleners explained.

“One would expect better vision if both eyes had successful cataract surgery in a short period of time — generally 2 to 6 weeks,” Dr. Meuleners said. “Therefore, ‘both eye’ patients may have lower risk of falls if vision is a risk factor.”

The U.S. Medicare study, she noted, did not look separately at patients who’d had surgery in only one eye or had both eyes done with a short wait in between.

Dr. Meuleners said it’s possible that the surgery, or the sedatives used during the procedure, worsened certain health problems for some patients in her study — especially the most elderly — noting that the post-surgery increase in fall risk was largely among patients age 80 and up.

For now, she recommended that people having cataract surgery talk with their doctors.

She also suggested they discuss whether a sedative is necessary during surgery.

Then there is the question of when to have the second eye done, if needed.

“One would think that timely second eye surgery would be beneficial,” Dr. Meuleners noted. “So careful consideration should be given to wanting (or needing) to postpone second eye surgery.”


J Am Geriatr Soc, 2012.