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Lisa Keay, Kam Chun Ho, Kris Rogers, Peter J McCluskey, Andrew JR White, Nigel Morlet, Jonathon Ng, Ecosse Luc Lamoureux, Konrad Pesudovs, Fiona Stapleton, Rebecca Q Ivers, Anna Palagyi; Reductions in the incidence of falls after first and second eye cataract surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1389. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the impact of first and second eye cataract surgery on the incidence of falls.
Patients aged 65 years and older on Australian cataract surgery waiting lists were invited to participate in a longitudinal study evaluating falls risk. Falls were reported prospectively over 24 months using monthly calendars with active follow-up, the dates of cataract surgery were extracted from medical records and habitual binocular visual acuity (VA) measured with an EDTRS chart (letter scored) at baseline and 3 months after surgery. The number of falls were modelled using an age and sex-adjusted negative binomial regression model with log of the years of observation as the offset, to estimate the impact of first and second eye cataract surgery on the incidence of falls.
The 418 participants were 75±8 years old (mean ± standard deviation [SD]) and 223 (54%) were female. Pre-operative VA was 0.27 logMAR (95% confidence interval [CI] 0.25-0.29, 6/12-2 Snellen equivalent), 0.14 logMAR (95% CI, 0.11-0.17, 6/7.5-2) after first eye surgery and 0.06 (95% CI 0.03-0.09, 6/6-3) after second eye surgery. Falls data were available for 398 participants pre-surgery for 7.6±7.1 (mean±SD) months, 336 participants between first and second eye surgery for 10.4±7.1 months and 192 participants post second eye surgery for 6.6±2.2 months. The age and sex-adjusted annual incidence of falls was 1.21 (95% CI 0.97-1.51] pre-surgery, 0.84 (95% CI 0.66-1.06) between first and second eye surgery, and 0.58 (95% CI 0.53-0.79) post-surgery. There was a similar reduction in annual falls incidence following first eye surgery (Incidence Rate Ratio [IRR] 0.69, 95% CI 0.51-0.88 referent ‘pre-surgery’) and second eye surgery (IRR 0.69, 95% CI 0.48-1.00 referent ‘between surgeries’). The incremental reduction in falls rate with second eye surgery was not statistically significant (p=0.051). However, less than half of participants (192/418, 46%) received second eye cataract surgery within the 24 month study, limiting the statistical power for this comparison.
This study shows that while vision is substantially improved after first eye cataract surgery, the incidence of falls is lowest after second eye surgery (approximately 50% of the pre-surgery falls rate) when full binocular vision is restored. These findings contribute evidence for planning surgical services to minimize the negative impacts of cataract in older people.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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