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Expedited cataract surgery doesn't reduce falls.

"Expedited" cataract surgery occurring within 4 weeks of diagnosis did not significantly reduce falls among elderly women, according to a metaanalysis of two randomized controlled trials.

That's despite a sevenfold improvement in sight following surgery, compared with elderly cataract patients who were scheduled for surgery but were stuck on 12-month wait lists.

Nevertheless, "extensive wait times for cataract surgery are a global health care issue" and a major cause of preventable blindness, wrote the authors of the current analysis. "Focusing resources on expedited cataract surgery would reduce the extensive waiting lists, influencing the health of the elderly population" (J. Cataract Refract. Surg. 2010;36:13-9).

The authors, led by Ediriweera Desapriya, Ph.D., of the department of developmental neurosciences and child health at the University of British Columbia, Vancouver, sorted through 234 studies found in 12 databases, including Medline, that mentioned "expedited cataract surgery." Only three looked at outcome measures for both improvement of vision and reduction of injury. Just two studies, comprising 535 women over age 70, looked at falls specifically.

"Expedited" surgery was defined as occurring within 4 weeks of diagnosis in the two studies included in the falls analysis (Br. J. Ophthalmol. 2005;89:53-9; Age and Ageing 2006;35:66-71); the third study, which appeared only in the vision analysis, extended the definition to 6 weeks (Lancet 1998;352:925-9). "Routine" surgery in the first two trials occurred at 12 months after diagnosis and had not occurred yet at the time of analysis; in the vision-only study, it took place at 7-12 months.

Looking at all three studies, which included 372 patients in the routine surgery group and 365 expedited surgeries, "'Expedited cataract surgery was associated with significantly enhanced visual acuity" at 6 months, compared with patients who had not yet had the procedure (odds ratio, 7.22; 95% confidence interval 3.15-16.55).

In the two studies that looked at falls, although there was a trend toward fewer falls after expedited surgery (76 out of 274 patients), compared with standard surgery (87 out of 271 patients), for an OR of 0.81, the result did not reach significance (CI 0.55-1.17). Both studies in the fails analysis were based on patient diaries.

Although a metaanalysis of only two studies may seem inadequate, the authors wrote: "When definitive and large trials have not been performed to evaluate the impact of expedited cataract surgery on the incidence of falls, a meta-analysis of all available trials could help resolve some important issues, reducing the need for large, costly new trials.'"

The two studies reported differences in predicted falls between men and women who have undergone cataract surgery. The age of the subjects could be a factor as the literature shows the rate of falls increases after age 70, they wrote. Also, fragile, more easily broken bones that can result from "clinical conditions that primarily affect women in their postmenopausal years, such as osteoporosis, may increase the damage caused by falls and other injuries," the authors said.

In noting the limitations of their analysis, the authors said both selected trials "'had insufficient power, and the dropout rate was 7.8%. Significant cases were lost to follow-up in both trials (10.7%)." the authors said. "'Future high-quality [randomized clinical trials] are recommended," they said.


Major Finding: Fewer falls occurred after expedited surgery (76 out of 274 patients), compared with standard surgery (87 out of 271 patients), for an OR of 0.81; the result did not reach significance (CI 0.55-1.17).

Data Source: A metaanalysis of two studies with a total of 535 women who had cataract surgery.

Disclosures: None of the investigators had any conflicts to report.
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Author:Napoli, Denise
Publication:Family Practice News
Geographic Code:1USA
Date:Feb 15, 2010
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