Patients with a dementia diagnosis are at greater risk of requiring a “complex” cataract surgery that lasts longer than 30 minutes, but they do not have a greater likelihood of postoperative complications, according to researchers.
By 2025, investigators project that 14 million Americans will have a dementia diagnosis. To preserve cognitive resilience of those with dementia, maintenance of neurosensory function is critical, according to a study recently published in the American Journal of Ophthalmology. Cataract surgery can have a particular benefit to these patients.
“Beyond improving vision, cataract surgery may have cognitive benefit in dementia; preliminary data from a short-term 122-patient clinical trial suggests better cognitive outcomes after 6 months among dementia patients who underwent cataract surgery versus those who do not,” the study authors write.
Even with this potential benefit, patients with dementia are less likely to receive cataract surgery. The authors explain that because the surgery may be more difficult in the setting of dementia, there can be more hesitation around the procedure from patients, caregivers, and providers. But, while the study shows unique surgical characteristics for these cases, rates of complications for these patients are not elevated.
The researchers examined 457,128 beneficiaries of Medicare insurance undergoing first-eye cataract surgery, 23,332 (5.1%) with a dementia diagnosis. They reported that none of the evaluated surgical complications, such as returns to the operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, new glaucoma or choroidal detachment, were more likely in the patients with dementia. Also, the study reports no differences in likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization.
However, when investigating the differences in surgical characteristics, the authors write that patients with dementia were more likely to have surgeries coded as complex (15.6% of cases versus 8.8%, P <.0001), and surgeries exceeding 30 minutes (OR=1.21, 95%CI=1.17-1.25). The site of surgery, anesthesia provider type, duration of surgery and transition to a higher acuity setting after surgery all can contribute to procedures being more complex.
Other notable differences are that patients with a dementia diagnosis had longer hospital stays (by approximately 2.9 days) after cataract surgery compared with their counterparts without a dementia diagnosis. Those with a dementia diagnosis had substantially lower odds of a retinal tear diagnosis at 90 days compared with patients without a dementia diagnosis (OR=0.30, 95% CI=0.10-0.94 among beneficiaries having second eye cataract surgery with 90 days, and OR=0.31, 95% CI=0.12-0.85 among beneficiaries who did not have second eye cataract surgery within 90 days).
The study’s authors write that, while more research is needed, there is “robust evidence that cataract surgery has value in the setting of dementia.”
Benefits of the receiving cataract surgery specifically for patients with dementia include rates of depression, potentially improved cognitive trajectory outcomes and improvement in the rate of decline of episodic memory scores.
If there’s no difference in risk of complications, the study suggests that cataract surgery should be considered more frequently for patients with dementia.
Pershing S, Henderson V, Goldstein M, et al. Cataract surgery complexity and surgical complication rates among Medicare beneficiaries with and without dementia. Am J Ophthalmol. Published online August 20, 2020. doi: https://doi.org/10.1016/j.ajo.2020.08.025