Aim To investigate the association of self-reported cataract surgery with all-cause and cause-specific mortality using a large-scale population-based sample. Methods Data from the 1999-2008 cycles of the National Health and Nutrition Examination Survey were used. A self-reported history of cataract surgery was considered a surrogate for the presence of clinically significant cataract surgery. Mortality data were obtained from the records of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) for survival were estimated using Cox proportional hazards regression models. Results A total of 14,918 participants were included in the analysis. During a median follow-up of 10.8 (interquartile range, IQR, 8.25-13.7) years, 3966 (19.1%) participants died. Participants with self-reported cataract surgery were more likely to die from all causes and specific causes (vascular disease, cancer, accident, Alzheimer’s disease, respiratory disease, kidney disease, and others) compared to those without (all Ps < 0, 05). The association between self-reported cataract surgery and all-cause mortality remained significant after multiple adjustments (HR = 1.13, 95% CI: 1.01 to 1.26). For cause-specific mortality , multivariable Cox models showed that self-reported cataract surgery predicted a 36% increased risk of vascular-related mortality (HR = 1.36, 95% CI: 1.01 to 1). ,82). The association with other specific causes of mortality did not reach statistical significance after multiple adjustments. Conclusions This study found significant associations between self-reported cataract surgery and vascular and all-cause mortality. Our findings provide potential insights into the pathogenic pathways underlying cataracts. |
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Clinically significant cataract linked to increased risk of vascular death
The risk of death from strokes, heart attacks and other vascular causes increased by more than a third.
Clinically significant cataract is associated with an increased risk of death from vascular causes, such as stroke and heart attack, suggests research published online in the British Journal of Ophthalmology .
Cataract surgery is the only effective treatment for cataracts, a leading cause of blindness and visual impairment, and consequently, the most frequently performed ophthalmic procedure. Researchers may use it as a surrogate for a clinically significant cataract.
Several studies have looked at the association between cataract surgery and all-cause mortality, but they have produced conflicting results, so the authors set out to investigate the association between cataract surgery and death by looking at deaths from specific causes.
The authors accessed data on 14,918 people aged 40 years or older who had participated in the 1999-2008 cycles of the National Health and Nutrition Examination Survey in the United States. This included 2,009 people (9.61%) who reported that they had undergone cataract surgery.
Deaths were tracked over a mean follow-up period of 10.8 years during which 3966 (19.1%) participants died. Death from all causes was more likely in people who had self-reported cataract surgery, as were deaths from certain specific causes, such as vascular disease, cancer, accident, Alzheimer’s disease, respiratory disease, and kidney disease.
After accounting for a variety of socioeconomic and health factors, only the association between self-reported cataract surgery and vascular-related mortality remained significant.
The risk of death from any cause was 13% higher in people who self-reported cataract surgery compared with participants who had not had surgery, and the risk of death from vascular causes was 36% higher .
No significant association was observed specifically between self-reported cataract surgery and cancer, respiratory diseases, kidney diseases, Alzheimer’s disease, or accidents.
The authors suggest that oxidative stress, crystallinity or depression may be the common factor linking cataract with an increased risk of vascular death.
Studies have shown that DNA damage induced by oxidative stress contributes to cataract formation and promotes atherogenesis.
Crystallins are major components of the lens and are also involved in regulating responses to stressors such as inflammation and ischemia. Lens degeneration that occurs in cataracts may represent a more generalized disorder that contributes to increased vascular mortality. .
Patients with cataracts have been shown to be more likely to develop depression than those without the condition, even after having cataract surgery, and people with depression are at higher risk of developing CVD.
This is an observational study and as such cannot establish cause, and the authors also highlight several potential limitations. Self-reported cataract surgery was used as a surrogate for clinically significant cataract, which meant that some cases of cataract may have been missed and it was not possible to determine the type of cataract affecting patients and whether specific types of cataract were associated. with deaths from specific causes.
However, the authors conclude: “This study found significant associations between self-reported cataract surgery and vascular and all-cause mortality. "Further studies are needed to confirm these associations and further investigate the mechanisms behind these associations."
