Cataract surgery not tied to longer life for women, after all

[September 01, 2018]  By Lisa Rapaport

(Reuters Health) - While older women may have a better quality of life and better vision after surgery to remove cataracts, newly reanalyzed data suggest they shouldn't base their decision to have the surgery on whether it will help them live longer.

In a paper last year in JAMA Ophthalmology, researchers concluded that women who opted for cataract surgery were 60 percent less likely to die from all causes during the study period than women who didn't. Their findings were drawn from 74,044 women with cataracts, including 41,735 who underwent cataract surgery.

But the authors retracted their paper last week, noting that they had failed to account for the time that lapsed between the diagnosis of cataracts and the surgery to remove them.

Many news outlets, including Reuters, had reported on the now-retracted study. (https://reut.rs/2orCrmz)

"With cataract surgery, there can be a 10- to 20-year delay between diagnosis and treatment because the surgery is elective," senior study author Dr. Anne Coleman of the David Geffen School of Medicine at the University of California, Los Angeles told Reuters Health by email.

When researchers accounted for the time between diagnosis and surgery for women who got operations, and also for how long women with cataracts survived when they didn't get surgery, the cataract surgery was now associated with a higher risk of death from all causes during the study period.

"With this additional factor, it appears that not having surgery (is associated with) longer life, but it is not a cause-and-effect relationship," Coleman said.

"The decision to proceed with cataract surgery should be based on several factors related to visual and overall physical functioning, after a complete assessment and discussion between a patient and his or her family, caretakers, and cataract surgeon," she said.

From 1993 to 2013, 6,878 women in the study who had cataract surgery died, as did 6,123 women with cataracts who didn't get the procedure, researchers reported in the original paper.

Women in the study were 71 years old, on average, the original paper stated. They were participating in the Women's Health Initiative, a long-running study that collects information on demographics, medical conditions and lifestyle habits.

Cataracts often develop with age. By age 80 roughly half of Americans either have cataracts or have had cataract surgery, according to the National Eye Institute.

With a cataract, the lens in the eye becomes cloudy and things look blurry or less colorful than they should. During cataract surgery, the damaged lens is removed and replaced with an artificial lens that helps restore clear vision.

Several previous studies have linked cataract surgery to lower odds of premature death for both men and women, Coleman said.

Cataracts can't be prevented, but there are benefits to treating them, said Dr. Justine Smith, author of editorial published with the original study.

However, the retraction illustrates the difficulty of trying to determine whether cataract surgery directly impacts how long people live, Smith, a researcher at Flinders University in Adelaide, Australia, said by email.

"These events provide a great example of good science: good scientists are constantly re-evaluating their work, and are always interested to receive questions from other scientists about that work," Smith said.

SOURCE: http://bit.ly/2NbsV52 JAMA Ophthalmology, online August 23, 2018.

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