Harvard Health Publications

Cataract removal linked to fewer hip fractures

Posted By Robert Shmerling, M.D. On August 1, 2012

There are several good reasons to have cataracts fixed. Restoring clear, colorful vision certainly tops the list. A study published today in the Journal of the American Medical Association (JAMA) adds another benefit—a lower risk of breaking a hip.

How could cataract surgery affect hip fractures? “Seeing helps you navigate a new environment and helps with balance,” lead investigator Dr. Anne L. Coleman of Brown University told the New York Times. “You really need your eyes and vision to help you stay stable.”

Coleman and her colleagues analyzed the effect of cataract surgery on the frequency of hip fracture in the following year. Among more than a million adults ages 65 and older who had cataracts:

  • about 1.3% suffered hip fractures
  • the frequency of hip fracture was 16% lower among those who had cataract surgery compared with those who didn’t have it.
  • the reduction in risk was even greater (23%) if the cataract was severe.

These are remarkable and important findings. They provide additional incentives for people with cataracts who are considering having cataract surgery.

Fixing cataracts

Cataracts are cloudy areas in the lens of the eye. This transparent structure focuses images on the light-sensitive retina. Cataracts occur when proteins in the lens form abnormal clumps that gradually get larger. Eventually they distort or block the passage of light through the lens and interfere with vision. “Cataract” means “huge waterfall,” which is how some people describe their clouded sight—like trying to look through a waterfall.

Drugs, eye drops, diets, exercises, or glasses can’t reverse the problem. Surgical removal of the clouded lens is the only effective cure for cataract. For most people, the only choice is when to undergo the procedure. The JAMA study and earlier work suggests that acting before vision becomes too impaired may be best.

Once an inpatient procedure requiring up to a week of hospitalization, cataract surgery is today performed under local anesthesia on an outpatient basis. It is considered one of the safest of all surgeries.

Here’s how cataract surgery is usually done: The surgeon makes a small incision in the eye. The damaged lens is removed one of two ways—surgically, in a process called extracapsular extraction, or using high-frequency sound waves. The latter procedure, called phacoemulsification, is the most common today. The surgeon inserts a needle-like probe through the incision. Sound waves are directed at the lens, breaking it apart, and the pieces are suctioned out of the eye. A new artificial lens is then placed inside the eye. (See “Cataract Surgery” below.)

Other benefits of cataract surgery

Besides the immediate benefit of improved vision on everyday activities, and the longer-term one of preventing broken hips, cataract surgery may have other, less obvious benefits. These include:

  • More independence. Most cataract sufferers are older adults for whom vision trouble threatens the prospects of living independently.
  • Better physical fitness. A person with poor vision may be afraid to go out for a walk or get other exercise. Improved vision could encourage more physical activity and all of the medical benefits that follow (such as a lower risk of diabetes and heart disease).
  • Better mental health. Loss of visual cues can contribute to confusion, especially in unfamiliar surroundings. And, the loss of independence and constriction of activities that come with failing vision may trigger depression.

In the future, it’s likely that cataract surgery will become even safer and more routine. Hopefully, we will discover ways to prevent cataracts. As the effectiveness of screening and treatment for eye disease improves, the importance of getting eye check-ups will only increase.

Cataract surgery

From The Aging Eye, a Special Health Report from Harvard Medical School

Related Information: The Aging Eye: Preventing and treating eye disease

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