Joo Hyundeok, Diaz-Ramirez L Grisell, Chen Catherine L, Sun Catherine Q, Smith Alexander K, Boscardin W John, Whitlock Elizabeth L
Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA.
Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
J Am Geriatr Soc. 2025 Apr;73(4):1073-1081. doi: 10.1111/jgs.19372. Epub 2025 Jan 11.
Cataract surgery is the most common surgical procedure performed for older US adults. Cataracts are associated with poor cognition and higher rates of dementia, but whether cataract surgery improves cognition for US older adults is not known. We examined the relationship between cataract surgery and long-term change in cognition in the Health and Retirement Study, a population-based study of older US adults linked with Medicare billing data.
We analyzed community-dwelling participants who underwent cataract surgery between 2000 and 2018, propensity-matched on age, sex, education (four levels), diabetes status (four levels), pre-procedural latent cognition, vision impairment, and interview timing and mode to older adults who did not have cataract surgery during the study period. Cataract surgery date was ascertained using Medicare billing data. We calculated latent value of cognition using biennial self/proxy cognitive assessments, and used linear mixed effects models adjusting for demographic and health factors to model cognition from 5 years before, to 5 years after, cataract surgery (or a simulated event, for controls). The primary measure was difference-in-differences estimate of latent cognition comparing the year prior, to the year after, cataract surgery or a simulated event.
We analyzed 4384 older adults who underwent cataract surgery and 4384 matched controls (mean [SD] age 76.1 [6.8] years, 62.0% women, 83.9% non-Hispanic white). Across the first postoperative year, cataract surgical participants declined 0.002 (-0.002 to 0.006) units faster than nonsurgical controls (p = 0.37), equivalent to 8 (-10 to 26) days more cognitive aging. Post hoc subgroup analyses also found no difference in cognition for groups stratified by pre-procedural latent cognition (i.e., normal vs. cognitively impaired) or vision (i.e., vision-impaired vs. intact).
Under typical United States practice, cataract surgery for older patients was not significantly associated with cognitive improvement or decline in the year after, compared with the year before, surgery.
白内障手术是美国老年成年人最常进行的外科手术。白内障与认知能力差和痴呆症发病率较高有关，但白内障手术是否能改善美国老年成年人的认知能力尚不清楚。我们在健康与退休研究中研究了白内障手术与认知能力长期变化之间的关系，该研究是一项基于人群的美国老年成年人研究，并与医疗保险计费数据相关联。
我们分析了2000年至2018年间接受白内障手术的社区居住参与者，根据年龄、性别、教育程度（四个级别）、糖尿病状态（四个级别）、术前潜在认知、视力障碍以及访谈时间和方式，与研究期间未进行白内障手术的老年人进行倾向匹配。白内障手术日期通过医疗保险计费数据确定。我们使用两年一次的自我/代理认知评估计算认知的潜在值，并使用调整了人口统计学和健康因素的线性混合效应模型来模拟白内障手术前5年至手术后5年（或对照组的模拟事件）的认知情况。主要测量指标是比较白内障手术或模拟事件前一年与后一年潜在认知的差异估计值。
我们分析了4384名接受白内障手术的老年人和4384名匹配的对照组（平均[标准差]年龄76.1[6.8]岁，62.0%为女性，83.9%为非西班牙裔白人）。在术后的第一年，白内障手术参与者的认知能力下降速度比非手术对照组快0.002（-0.002至0.006）个单位（p = 0.37），相当于认知衰老多了8（-10至26）天。事后亚组分析还发现，按术前潜在认知（即正常与认知受损）或视力（即视力受损与正常）分层的组在认知方面没有差异。
在美国的典型实践中，与手术前一年相比，老年患者的白内障手术在术后一年与认知改善或下降没有显著关联。
