I admit that title is stretching it a bit, but a recent study shows that patients undergoing cataract surgery had a lower risk of death. The study itself is impressive because it correlates data from 2 large sources: the Medicare Claims Database and the Women’s Health Initiative. A total of more than 74 000 patients in the cohort had a diagnosis of cataract and more than 40 000 of them had cataract surgery performed between 1993 and 2015. Cataract surgery was found to be associated with a lower risk of overall death as well as for cause-specific mortality. The study authors are careful to remind us that cataract surgery itself didn’t necessarily prolong the patients’ lives, but certainly it was associated with a lower risk of death.
The senior author on the paper, Anne Coleman, MD, PhD, taught me more than 20 years ago, when I was her resident, that there is a lot to learn from large groups of data. At that time, we analyzed the Medicare Claims Database to show a surgical undertreatment of glaucoma among certain subgroups. Diving further into the data may provide other insights. For instance, patients diagnosed with prostate issues may have an increased rate of cataract surgery reoperations, such as pars plana lensectomy, for retained lens fragments. Figuring out why use of alpha 1 blocker induces intra-operative floppy iris syndrome is more difficult.
As ophthalmologists, we tend to focus on the quality of life improvement after cataract surgery because that’s what we see in the postoperative period. My favorite clinic day is the day after cataract surgery, where patients voice happiness for their much-improved vision. Taking a step back, we can understand that these benefits go beyond improving the quality of life. The increased vision can provide other benefits, such as decreasing the fall risk or improving night-driving vision, both of which could mean a longer life.
But cataract surgery is not perfect, and it is not without risk. Even with a very high success rate, the millions of cataract surgeries done each year in the US are associated with thousands of complications, including vision loss. I’m sure that this same large database can show that cataract surgery may be associated with a higher risk of retinal detachment. Big data can teach us a lot, including things that we suspect are true but don’t want to be reminded of.