Vision and cataract surgery: eyesight, falls and glasses

Harwood et al. (2005; PMID 15615747): corrected binocular acuity improved by 0.25 logMAR units after first-eye surgery; 8% of operated women had acuity worse than 6/12 against 37% of those waiting. Foss et al. (2006; PMID 16364936): visual function, especially depth perception (stereopsis), improved after second-eye surgery. Desapriya et al. (2010; PMID 20117700): pooled across three studies, expedited surgery increased visual acuity (OR 7.22, 95% CI 3.16 to 16.55). Acuity is measured on a chart, but both randomized trials come from one Nottingham group, so independent replication The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away. is not shown: B.

Harwood et al. (2005; PMID 15615747): 306 women over 70; over 12 months the rate of falling was 34% lower after expedited surgery (rate ratio 0.66, 95% CI 0.45 to 0.96, p = 0.03), and fractures occurred in 4 (3%) operated against 12 (8%) waiting women (p = 0.04). The share who fell at least once was not lower (49% operated against 45% waiting); the drop was in repeat falls (18% against 25% fell more than once). The Cochrane review (Gillespie 2012; PMID 22972103) lists this as the only first-eye trial. Pooling two randomized trials (535 participants) gave a nonsignificant reduction in falls (OR 0.81, 95% CI 0.55 to 1.17; Desapriya 2010, PMID 20117700). One positive trial, not repeated by another group: C.

Foss et al. (2006; PMID 16364936): the rate of falling was 32% lower but not statistically significant Unlikely to be explained by chance alone at the threshold the study set. It says nothing about whether the difference is large enough to matter. (rate ratio 0.68, 95% CI 0.39 to 1.19); confidence and visual disability improved. The Cochrane review (Gillespie 2012; PMID 22972103) states second-eye surgery did not reduce the rate of falls. Tested, no benefit shown on falls: D on Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale..

Cumming et al. (2007; PMID 17302652): in 616 frail older people, the group sent for full eye examinations and treatment fell more: 65% against 50% fell at least once, rate ratio 1.57. Computed from those percentages, about 150 more people per 1,000 fell in a year. The optometrist arranged new glasses for 92 people, cataract surgery referral for 15 and glaucoma care for 17. Day et al. (2002; PMID 12130606): treatment of poor vision showed no significant effect on falls. Clemson et al. (2023; PMID 36893804), Cochrane: vision improvement interventions may make little or no difference to falls. Man et al., ROC (2020; PMID 32075817): eye care in residential care improved near vision but did not change falls. Gillespie et al. (2012; PMID 22972103): the vision intervention increased the rate of falls (RaR 1.57). Treated group did worse: D on Route 2, harm found.

Haran et al., VISIBLE (2010; PMID 20501583): 606 multifocal wearers; distance glasses did not reduce falls overall. In people who regularly took part in outside activities, all falls, outside falls and injurious falls were lower; in people with little outside activity, outside falls rose, and the authors state the intervention may be harmful in that group. No benefit in the whole trial population, with benefit and harm in opposite subgroups: D on Route 2.

Campbell et al., VIP (2005; PMID 16183652): 391 people aged 75 and older with acuity of 6/24 or worse; an occupational therapist home safety program reduced falls (incidence rate ratio 0.59, 95% CI 0.42 to 0.83), while home exercise plus vitamin D did not (1.15, 95% CI 0.82 to 1.61); in a conservative analysis neither reduced fall injuries. Clemson et al. (2023; PMID 36893804), Cochrane, found home fall-hazard programs reduce falls in people selected for high fall risk generally, but the low-vision trial has not been repeated by another group: C.

Anstey et al. (2006; PMID 16961944): 56 patients with bilateral cataract randomized to surgery; no cognitive benefit in cognitively normal adults. Dementia itself has never been tested in a randomized trial; the dementia evidence is observational Research that watches what people already do rather than assigning a treatment. It can show that two things travel together, not that one causes the other. (excluded evidence). Tested, no benefit: D on Route 2.

Clarke et al. (2018; PMID 29460275), Cochrane: 10 trials, all funded by government agencies, low risk of bias. Screening did not improve vision. Tested, no benefit: D on Route 2.