Cataract surgery is that bright light breaking through the clouds, in more ways than one, after researchers link the procedure's youthful vision restoration with a comparative decreased risk of death.
Published in the May edition of Ophthalmology, the cohort study looked at a five-percent random sample of U.S. Medicare beneficiaries with a cataract diagnosis from 2002 to 2012 to parse the effects of surgery on all-cause mortality, concluding surgery did slightly decrease mortality incidence.
About 36% of the 1.5 million cataract patients studied underwent surgery, registering mortality incidence of 2.78 deaths per 100 person-years, versus 2.98 deaths per 100 person-years in patients without surgery. The study notes associations were strongest in women, 80-84 years old, living in the western U.S. with severe cataract and moderate systemic disease burden.
Exactly why this is the case isn't empirically known, and the study's authors say further studies are needed to examine these mechanisms. However, this isn't the first study to reach this conclusion about morbidity and cataract surgery.
A 2013 study published in Ophthalmology found cataract surgery correcting visual impairment resulted in a 40% reduction in mortality risk compared with no surgery at all. Using data from the Blue Mountains Eye Study, investigators studied 354 participants over 5 years finding this trend persisted after adjusting for a number of factors including smoking, diabetes, stroke history and number of medications.
Investigators noted that factors influencing this trend may "include physical and emotional well-being, optimism and improved confidence associated with independent living after correcting cataract-related visual impairment," Medscape cites.
Cataract care: Quantity and quality of life
Cataract, the clouding of the eye's normally clear lens, prevents light from focusing properly on the retina, resulting in vision impairment. The condition affects more than 24.4 million Americans age 50 and older, and by age 80, more than half of Americans either will have a cataract or have had cataract surgery, according to the National Eye Institute.
Reviewing the study, Bradley Lane, O.D., AOA Health Promotions Committee member, says it's obvious that removing cataracts to improve overall vision of the patient is essential to the individual's well-being.
"As we all know, clear vision is important for most all aspects of life experiences: A grandchild's graduation, weddings and making memories," Dr. Lane says. "We rely heavily on sight, and ensuring the patient has clear vision is much more than simply providing a pair of glasses. Because pathology can restrict a patient's vision, it is important for doctors of optometry to be aware of the ocular diseases and disorders that can inhibit optimal vision function, including cataracts."
So, too, is it important for doctors of optometry—as primary care eye physicians—to co-manage such patients in order to offer all treatment options, including surgery.
Dr. Lane adds: "We are positioned to be the patient's trusted advisor in all things eye care, and keeping this in mind, we have the opportunity to help the patient live a longer and more fulfilling life through clear, uninhibited vision."
Emphasizing optometry's role in co-managed care
Optometry is a crucial component to cataract care, not only in early detection and diagnosis, but also in referral for surgery and post-operative care.
In November 2015, Life Extension® magazine favorably highlighted doctors' of optometrys' role in an article titled, "How to Improve Your Odds of Successful Cataract Surgery." Its first recommendation: Find a doctor of optometry.
"The most independent source as to which ophthalmologist (eye surgeon) is the best surgeon is a good optometrist ... optometrists see the complications of an unsuccessful surgery and generally know what surgeons are bad, good and really good," the article states.
More notably, in September 2015, the American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgery (ASCRS) reversed a 15-year-old guidance that originally emphasized ethical concerns for co-management and concluded such models of care should be an exceptional occurrence. The revised AAO/ASCRS position paper deemed co-managed cataract care an "appropriate" course of action serving legitimate patient interests.
Diane Russo, O.D., AOA Health Promotions Committee member, says co-management is about delivering high-quality and appropriate care to patients.
"It is an opportunity to break down barriers to access that our patients may face," Dr. Russo says. "When optometrists and ophthalmologists co-manage cataract cases, patients are able to obtain needed access to care and maintain discretion to see the doctors they trust."
The American Diabetes Association® (ADA) reported, in time for National Diabetes Month in November, that total annual costs of diabetes in 2022 was $412.9 billion, most of it in direct medical costs. How can doctors of optometry help in the fight to lower the prevalence of diabetes?
Doctors of optometry should consider the benefits of adding office-based laser procedures, such as YAG capsulotomy (after cataract surgery) or selective laser trabeculoplasty (SLT, for glaucoma), to their practice.
Doctors of optometry are performing office-based laser procedures in 11 states, as AOA affiliates have seen historic scope expansion wins in the past four years and momentum continues to build. Doctors of optometry are pursuing legislation in other states that would allow them to serve their patients at the highest level of their education and training. Some of these optometrists, who have performed hundreds of laser procedures, share key considerations in providing this care to patients.