Survival of patients with cataract

The association between cataract and mortality among older adults

CONTEXT

Previous research has suggested that persons with cataract have an increased risk of death.

OBJECTIVE

To compare the mortality experience of patients with cataract who elect surgery, patients with cataract who do not elect surgery, and patients without cataract independent of potentially confounding risk factors.

DESIGN

Cohort study.

SETTING

Ophthalmology and optometry clinics affiliated with the Callahan Eye Foundation Hospital in Birmingham, Alabama.

PATIENTS

384 persons with and without cataract.

MAIN OUTCOME MEASURE

Mortality.

RESULTS

Of the 384 study subjects, 286 had cataract, of whom 200 elected to have cataract surgery. Patients with cataract who did and did not elect surgery had significantly higher mortality compared to those without cataract (crude mortality rate ratio (MRR) 3.9 (95% confidence interval (CI) 1.5-9.8) and 7.3 (95% CI 2.8-19.1), respectively). After adjustment for age, gender, race, education, chronic medical conditions, smoking, drinking, depression, and cognitive status, the no-surgery cataract group had an elevated mortality rate (MRR 3.2 (95% 1.2-9.0)), compared to the no-cataract group, with a borderline elevation in MR for the surgery group (MRR 2.0 (95% 0.8-5.9). Limiting the study population to non-diabetics or those without concurrent eye conditions (glaucoma, maculopathy, retinopathy) did not materially influence the adjusted MRRs although the precision of the estimates was reduced.

CONCLUSIONS

The results suggest that older persons with cataract, in particular those who decline surgery, have an increased risk of death, supporting the hypothesis that age-related cataract reflects systemic as well as localized ocular disease.

Increased mortality rates after cataract surgery. A statistical analysis

One hundred ninety-three patients 50 to 89 years of age had cataract surgery between January 1, 1979, and December 31, 1980, at West Virginia University Medical Center, Morgantown. In comparison with 182 patients who elected one of three other surgical procedures, cataract surgery patients had a significantly higher mortality rate (P = 0.0005) than control group patients, according to life-table analysis estimates adjusted for age and sex. Patients with adult onset diabetes mellitus had slight increased survival and did not alter relative mortality. The authors' results support the hypothesis that senile cataracts may reflect systemic factors in addition to localized ocular disease.