Study shows risk of falling remains after cataract surgery

December 14, 2015
Optometrists still need to help manage patients after surgery to prevent falls.

A new study has found that though cataract surgery can improve dizziness in patients, it doesn't always help reduce the risk of falls.

Falls are the most common cause of traumatic brain injury (TBI), so doctors of optometry's role in helping post-surgical patients reduce their risk of falls is critical.

Published in Ophthalmic and Physiological Optics, the study evaluated the dizziness and falls rates of 287 patients (average age 76.5) before and after routine cataract surgery. Six months after the surgery, the percentage of patients who reported dizziness dropped from 52% to 38%.

However, the percentage of patients who reported falling after surgery dropped only slightly, from 23% to 20%.

Researchers found a significant link between post-operative falls and the patient being switched to multifocal spectacles. David Lewerenz, O.D., chair of the AOA Vision Rehabilitation Section and associate professor at Northeastern State University Oklahoma College of Optometry, recommends that doctors talk to post-operative cataract patients about alternatives to multifocal lenses.

"Unrelated to their cataract surgery status, people who wear multifocal lenses have been shown to have increased fall rates," Dr. Lewerenz says. "If we sense that a patient is somewhat unsteady, and might be at relatively high risk for a fall anyway, we might talk to that patient about the option of having two pair of glasses—one for distance vision and one for reading—rather than going with multifocal glasses."

Reinforcing the role of doctors of optometry

The study's results once again highlight the crucial role doctors play in both pre- and postsurgical care of cataract patients . In fact, the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery released a position paper in September 2015 acknowledging that co-managed care often best serves the patient.

"A lot of people who have cataract surgery are going to be far better served by getting their follow-up care closer to home with their local optometrist," Dr. Lewerenz says. "Some people might not choose to go back for follow-up care at all if they have to travel too far. If they can see their hometown optometrist, that makes it all the more likely that they will receive the care they need."

If a cataract patient, or any other patient, does fall and experiences TBI, AOA has a new resource to help doctors treat them. The second addendum of the Brain Injury Electronic Resource Manual is now available: Volume 1B: Traumatic Brain Injury: Optometric Management and Advanced Topics. It can help doctors of optometry evaluate brain-injured patients. The first addendum, Volume 1A: Traumatic Brain Injury Visual Dysfunction Diagnosis, covers diagnosis of brain injuries.

"The brain injury manual has been a very popular and valuable resource among AOA members," Dr. Lewerenz says. "It could be a resource for optometrists who are treating or evaluating patients who have had head injuries from a fall or some other source."

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