Cataract-Related Visual Impairment Corrected by Cataract Surgery and 10-Year Mortality: The Liwan Eye Study

Abstract

PURPOSE. To assess 10-year mortality in people who had undergone cataract surgery with no residual visual impairment (VI) and those who had persistent VI due to cataract using a population-based cohort.METHODS. The Liwan Eye Study is a 10-year longitudinal study commenced in 2003. According to the World Health Organization, presenting VI was defined as visual acuity less than 20/63 in the better-seeing eye. History of cataract surgery was defined as cataract surgery performed on either eye. Information on the date of surgery was recorded. Dates of death occurring between baseline and April 30, 2014 were obtained from the National Death Index data. Information on socioeconomic factors was obtained from questionnaire interviews. Cox proportional hazards regression models were used to assess the hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS. Fifty-nine participants had undergone cataract surgery without residual VI and 67 participants had persistent cataract-related VI. The 10-year mortality rate for participants who had undergone cataract surgery without residual VI was statistically significant lower than that in participants who had VI due to cataract based on log-rank test (32.2% vs. 64.2%; P ¼ 0.002). This finding remained significant in the unadjusted Cox proportional hazards model (HR, 0.43; 95% CI, 0.25-0.74; P ¼ 0.002). After adjusting for age, sex, history of diabetes, and hypertension, body mass index (BMI), education level, and personal income, participants with cataract surgery and no residual VI did not have a higher chance of survival than participants with persistent VI due to cataract (HR, 0.56; 95% CI, 0.26-1.20; P ¼ 0.136).CONCLUSIONS. Cataract-related VI corrected by cataract surgery was not associated with better survival after adjusting for a number of possible confounders. Given our sample size is relatively small and limited power, further studies with larger sample are needed.

Effect of individual-level and socioeconomic factors on long-term survival after cataract surgery over a 30-year period

“…20 In another report covering a 10-year period, cataract surgery was not associated with better survival once confounding factors had been accounted for. 21 Our study confirms previous reports on Caucasian patients, which have shown that women have a lower mortality risk following cataract surgery than men. 22 …”

“…8,9 Some of these studies analysed data from large, administrative databases, 8,9,22 whereas others were epidemiological or longitudinal studies, 6,7,21 of a cross-sectional nature considering data from a single surgical centre, 4,5 or reviews of the literature. 20 Due to the differences in the study design, the sample size of patients who underwent cataract surgery varied substantially from several hundred [4][5][6][7]21 to several thousand surgical episodes included in the analyses. 8,9 Our results are in agreement with previous reports and confirm that survival after cataract surgery is largely good and mortality, at least initially, low.…”

“…9 A contrasting perspective has also been provided. 20,21 A systematic review of the literature indicated that cataract extraction was not associated with mortality risk. 20 In another report covering a 10-year period, cataract surgery was not associated with better survival once confounding factors had been accounted for.…”

Association of Age-Related Macular Degeneration With Risk of All-Cause and Specific-Cause Mortality in the National Health and Nutrition Examination Survey, 2005 to 2008

“…Extensive evidence supported increased risks of mortality among participants with other age-related ocular diseases. 61 , 62 , 63 To elaborate on the real nature of the AMD-mortality association, we also adjusted for comorbid ocular diseases in the final model, which did not affect the AMD-mortality association.…”

Cognitive Performance Concomitant With Vision Acuity Predicts 13-Year Risk for Mortality

“…However, a non-negligible disadvantage to gains in longevity is the increased risk of the impairment of both vision and cognition with age. VI is highly prevalent among aged people, not only leading to morbidity, but imposing an impact on the risk of mortality as well (Zhang et al, 2016; Zhu et al, 2016). It has been estimated that the number of visually impaired people could double by 2050 (Varma et al, 2016).…”