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Cataract surgery in both eyes 'halves incidence of falls'

Falls incidence among older Australians with cataract may be halved for those who have operations on both eyes compared with single-eye surgery, a study suggests.

The findings underline the importance of timely second-eye surgery to optimise mobility and healthy ageing, the researchers say.

The team drew on data from 409 patients (mean age 75) participating in the Falls in Older people with Cataract (FOCUS) study, who had been referred for bilateral cataract surgery at public hospitals in Sydney, Melbourne and Perth between 2013 and 2016.

The participants (aged 65 and older, 54% women) were followed for six months after their second surgery or for two years after study recruitment, whichever was shorter.

They submitted monthly self-report calendars to track their number of falls and underwent physical and vision-related assessments.

Overall, some 63 participants (15%) did not undergo any cataract surgery during the study period, while 188 participants (46%) progressed to second-eye cataract surgery.

Published in The Medical Journal of Australia, findings showed that the age-and-sex adjusted incidence of falls among patients was 31% lower after a first-eye surgery but dropped by a further 50% after second-eye surgery, when binocular vision was restored.

Researchers, led by UNSW Sydney and the George Institute for Global Health in Sydney, also found that binocular habitual visual acuity and bilateral log contrast sensitivity improved after both operations for the 118 patients who had surgery on both eyes and participated in all follow-ups.

“First-eye surgery substantially improves vision in older people with cataract, but second-eye surgery is required to minimise fall incidence,” they wrote.

They also recommended minimising the time between surgeries to allow for timely updates to patients’ glasses, which reduced between-eye differences in refractive error.

“Older people with cataract in Australia can wait for substantial periods for both first- and second-eye cataract surgery in the public hospital system,” they wrote.

“The problem has been exacerbated by deferral of elective surgery during the … COVID-19 pandemic and particularly affects people who rely on public hospital services.

“Our study adds to the body of evidence supporting investment in timely access to cataract surgery for older people, as it is cost-effective for improving vision and preventing falls.”