Longer life within sight, thanks to cataract op

ILLUSTRATION: THE NEW YORK TIMES NEWS SYNDICATE

New study finds 60% lower risk of death among women who had cataracts removed

After 72 very nearsighted years, 55 of them spent wearing Coke-bottle glasses, Ms Jane Quinn of Brooklyn, New York, is thrilled with how well she can see since having her cataracts removed last year.

"It's very liberating to be able to see without glasses," Ms Quinn told me. "My vision is terrific. I can even drive at night. I can't wait to go snorkelling."

And I was thrilled to be able to tell her that the surgery very likely did more than improve her poor vision. According to the results of a huge new study, it may also prolong her life.

The 20-year study, conducted among 74,044 women aged 65 and older, all of whom had cataracts, found a 60 per cent lower risk of death among the 41,735 women who had their cataracts removed.

The findings were published online in Jama Ophthalmology in October by Dr Anne L. Coleman and colleagues at the Stein Eye Institute of the David Geffen School of Medicine at the University of California, Los Angeles, with Dr Victoria L. Tseng as lead author.

A cataract is a clouding and discoloration of the lens of the eye. This normally clear structure behind the iris and pupil changes shape, enabling incoming visual images to focus clearly on the retina at the back of the eye.

When cataracts form, images get increasingly fuzzy, the eyes become more sensitive to glare, night vision is impaired and colour contrasts are often lost.

A cataract is a clouding and discoloration of the lens of the eye. This normally clear structure behind the iris and pupil changes shape, enabling incoming visual images to focus clearly on the retina at the back of the eye. When cataracts form, images get increasingly fuzzy, the eyes become more sensitive to glare, night vision is impaired and colour contrasts are often lost.

Cataracts typically form gradually with age, and anyone who lives long enough is likely to develop them. They are the most frequent cause of vision loss in people older than 40. Common risk factors include exposure to ultraviolet radiation (that is, sunlight), smoking, obesity, high blood pressure, diabetes, prolonged use of corticosteroids, extreme nearsightedness and family history.

Wearing sunglasses that block 100 per cent of UV rays and a hat are important preventives. Eating lots of foods rich in vitamin E (such as spinach, almonds, sunflower seeds and sweet potatoes); the carotenoids lutein and zeaxanthin (in kale, spinach and other dark green leafy vegetables), and omega-3 fatty acids (in spinach and oily fish like mackerel, salmon and sardines) may also reduce the risk of cataracts.

Cataract surgery is the most frequently performed operation in the United States, with more than three million Americans having cataracts removed each year, according to Prevent Blindness America.

With tiny instruments, the cloudy lens is sucked out of the eye and an artificial lens inserted in its place. After about half an hour in recovery, patients can go home.

"Not only can cataract surgery give people a better life while they're living it, they can also live more of it," Dr Coleman said in an interview.

The women in the study who underwent cataract surgery lived longer even though, overall, they were sicker to begin with - as a group, they had more heart attacks, chronic pulmonary disease, peptic ulcers and glaucoma than those who did not have surgery.

The new study showed that the operation can extend life. Those who had cataract surgery subsequently had reduced risks of death from cardiovascular, pulmonary, neurological and infectious diseases, as well as cancer and accidents.

When people can see better, "they can also move more and get more exercise", Dr Coleman said. "They can see their pills better and may be more likely to take them and take the right ones. The surgery also improves visual contrast, which decreases the risk of accidental deaths from falls or driving."

Although there are some risks associated with removing cataracts, "it's probably the most successful surgery we have - it has a 98 per cent success rate", Dr Coleman said.

Potential complications, albeit rare, include infection, inflammation, retinal detachment and double or shadow vision.

The artificial lenses used to replace the clouded ones now come in many varieties that can be geared to a patient's lifestyle, desires and medical requirements.

A marathon runner or tennis player may want a different kind of lens than a book editor.

Most often, the artificial lenses inserted correct poor visual acuity - Ms Quinn's went from 20/200 to 20/20, her serious astigmatism was gone, and she now needs only drugstore reading glasses.

But patients can choose lenses that correct near as well as distance vision; lenses that shift focus on near or distant objects in response to eye muscle movements; and bifocal or progressive lenses.

Ms Quinn, a social service administrator, has sage advice for anyone needing cataract surgery: "Do your homework. I encourage people to become well informed about the operation, its aftermath and the various lens options now available."

NYTIMES

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