Effect of increasing age on cataract surgery outcomes in very elderly patients

The safety and effectiveness of cataract surgery are generally well established.1 About 90% of eyes achieve a visual acuity of 6/12 or better after cataract surgery.2 In eyes with no pre-existing comorbidity, more than 95% can be expected to achieve this outcome. Many other studies have documented substantial improvement not only in visual acuity but also in quality of life after cataract surgery.3^–5

Outcomes from cataract surgery may be poorer in very elderly people

In the very elderly population (say, those aged over 85 years), however, these issues are not entirely clear. In the 1997-8 UK national cataract surgery survey, more than a third of participants aged 85 years and older did not achieve visual acuities of 6/12 or better after cataract surgery.5 These people were also two to three times more likely to have severe impairment in one eye (visual acuity of 6/60 or worse) than younger people. With greater life expectancies and increasing demand for improved quality of life, the number of very elderly people receiving cataract surgery has been projected to grow substantially in the coming years. Among people aged 85 and older in England and Wales, about 500 000 people are estimated to have cataracts with some degree of visual impairment, with 100 000 new cases of cataract every five years.6

Among these very elderly people, are some more likely to benefit than others? Conversely, which patients are at risk of developing adverse events? How does old age affect outcomes of cataract surgery? The answers to these questions are important not only to the elderly patient contemplating cataract surgery and the doctor deciding if cataract surgery is indicated, but also to the government, insurers, and other healthcare payers, as cataract surgery delivery is increasingly under pressure from cost containment …