Cataract Surgery Reduces Hip Fractures (Orthopedics This Week)
It only makes sense…if you can see better, then you see that thing you’re about trip over. Researchers from the University of California, Los Angeles (UCLA) and Brown University have found that Medicare patients 65 years and older who underwent cataract surgery had a lower odds of hip fracture one year after the procedure when compared with patients with cataract who did not have cataract surgery. Their study appears in the August 1 issue of the Journal of the American Medical Association.
Victoria L. Tseng, M.D., of the Warren Alpert Medical School of Brown University, Providence, Rhode Island, and colleagues examined the association between cataract surgery and fracture incidence at one year. The study included a 5% random sample of Medicare Part B beneficiaries with cataract who received and did not receive cataract surgery from 2002 through 2009.
There were 1,113,640 Medicare beneficiaries 65 years and older with a diagnosis of cataract between 2002 and 2009 in the 5% random sample. Of patients with cataract, 36.9% underwent cataract surgery during the study period. During this period, the overall one-year fracture incidence was 1.3% for hip fractures. Analysis of the data indicated that cataract surgery was associated with a 16% decrease in the adjusted odds of hip fracture one year after the procedure. “In patients with severe cataract, the association between cataract surgery and lower odds of hip fracture was even stronger, with a 23% reduction in the adjusted odds of hip fracture in the cataract surgery group compared with the cataract diagnosis group,” the authors wrote in the July 31, 2012 news release.
Osteoporosis was the most common fracture-related comorbidity (co-existing illness) (12.1%). The most common ocular comorbidity was glaucoma (19.1%).
The study’s principal investigator was Anne Coleman, M.D., Ph.D., an ophthalmologist with the University of California, Los Angeles. When asked what stands in the way of more patients this age getting the surgery, she told OTW,
Many patients do not realize how much their poor vision is affecting them because their vision has slowly gotten worse over the years, and they have made lifestyle adjustments such as not driving at night. They think that poor vision is a normal part of the aging process so they do not desire to have surgery. Another possible reason is that providers might be uncertain about recommending a surgical procedure for patients over 80.
Asked what else she would like orthopedists to know about this issue, Dr. Coleman commented to OTW,
When a patient with a fracture presents to their office or emergency room, it would be very helpful to make sure that the patient has been evaluated by an ophthalmologist for vision loss secondary to cataracts or other treatable conditions. If they haven’t, please refer them.