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Clinically significant cataract linked to increased risk of all-cause and vascular death

By Melanie Hinze
Clinically significant cataract is associated with both all-cause and vascular mortalities, suggests research published in the British Journal of Ophthalmology.

In their population-based study, researchers assessed data from almost 15,000 participants aged 40 years or older from the 1999 to 2008 cycles of the US National Health and Nutrition Examination Survey. Of these participants, 2009 reported that they had undergone cataract surgery, which the researchers used as a surrogate for clinically significant cataract. Over a median follow up of 10.8 years, 3966 of the total cohort died.

Participants with self-reported cataract surgery had a 13% increased risk of dying from all causes, even after adjusting for a range of factors including age, sex and ethnicity; educational attainment; smoking status; alcohol consumption; diabetes mellitus; hypertension and hypercholesterolaemia.

Self-reported cataract surgery was also associated with a 36% increased risk of vascular-related mortality after multiple adjustments. Although it increased the risk of dying from other specific causes, including cancer, accident, Alzheimer’s disease, respiratory disease and renal disease, these associations did not reach statistical significance.

The researchers called for more studies to investigate the mechanisms behind these associations but suggested that oxidative stress, degeneration of crystallins or depression could be involved.

Professor Stephanie Watson, Head of the Corneal Research Group at The University of Sydney, and Head of the Corneal Unit and Sydney Eye Hospital, Sydney, said that among elderly patients cataract surgery was common and she questioned whether GPs should change their management of patients who have cataracts and might need surgery.

‘Interesting data from this large study suggests that cataract surgery, and thus cataracts, may be an indicator of general health, particularly vascular disease,’ she said, adding that other large studies had supported the study’s findings.

‘It might now be time for GPs to consider general health assessments focusing on risk factors for vascular disease when they learn their patient has cataracts,’ she told Medicine Today.
Br J Ophthalmol 2021; doi: 10.1136/bjophthalmol-2021-319678.