Seek an eye specialist's assessment when cataracts impair an older person's vision; take care between operations

Cost: Accompany the older person for assessment and let the clinician decide whether surgery is appropriate. The source describes many hospitals using day surgery and separate procedures for each eye. Out-of-pocket costs depend on the artificial lens and local insurance; ask beforehand.

In plain language: One randomized trial in women older than 70 found fewer total falls after expedited first-eye surgery, but not fewer people experiencing at least one fall. Second-eye surgery did not show a statistically clear fall-rate reduction in a separate trial. Observational records associated surgery with fewer hip fractures, without establishing causation.

Findings reported by the source: A trial included 306 women older than 70 with cataracts, assigned to first-eye surgery in around four weeks or the ordinary approximately 12-month wait. At one year, the expedited group had a fall-rate ratio of 0.66 (95% CI 0.45–0.96). At least one fall occurred in 49% versus 45%, while recurrent falls occurred in 18% versus 25%. Four surgery-group participants fractured (3%) versus 12 waiting-group participants (8%). The cited Cochrane review distinguished first-eye fall-rate benefit from the second-eye result. A second-eye trial in 239 women older than 70 had a rate ratio of 0.68 (0.39–1.19), compatible with no clear difference.

US Medicare records for 2002–2009 included 1,113,640 cataract patients aged 65 or older. This observational analysis associated surgery with hip-fracture OR 0.84 (95% CI 0.81–0.87) within one year, an absolute difference of 0.20 percentage points, around two fewer cases per thousand.

Source author's evidence grade: B; not site verification or professional approval.

Notes and dispute: Combining two randomized trials did not clearly reduce the number of people who fell (OR 0.81, 95% CI 0.55–1.17). Western Australian hospital records instead showed 27% more admissions for fall injuries in the year after first-eye surgery, and 2.14 times the preoperative rate between the two operations. Before-and-after records cannot separate surgery effects from ageing. Another Australian cohort found the greatest fall-rate reduction after second-eye surgery. The source therefore advises discussing timely second-eye treatment where both eyes are affected and being especially careful walking or using stairs between procedures. Cochrane also included an intervention for older people's vision problems with an approximately 57% higher fall rate. Improving vision is not a complete fall-prevention strategy: see chapter 1, entry 13 for balance and leg strength, and entries 39 and 40 for bone-density assessment and osteoporosis treatment. China's cited eye-health plan describes cataract surgery as widely available at county level, without necessarily travelling to a major city. The source particularly considers parents and grandparents.

Original source bibliography (titles retained as supplied): Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T (2005). Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. British Journal of Ophthalmology, 89(1), 53-59. https://doi.org/10.1136/bjo.2004.049478 ; Foss AJ, Harwood RH, Osborn F, Gregson RM, Zaman A, Masud T (2006). Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age and Ageing, 35(1), 66-71. https://doi.org/10.1093/ageing/afj005 ; Gillespie LD, Robertson MC, Gillespie WJ, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9, CD007146. https://doi.org/10.1002/14651858.CD007146.pub3 ; Tseng VL, Yu F, Lum F, Coleman AL (2012). Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA, 308(5), 493-501. https://doi.org/10.1001/jama.2012.9014 ; Desapriya E, Subzwari S, Scime-Beltrano G, et al. (2010). Vision improvement and reduction in falls after expedited cataract surgery: systematic review and metaanalysis. Journal of Cataract and Refractive Surgery, 36(1), 13-19. https://doi.org/10.1016/j.jcrs.2009.07.032 ; Meuleners LB, Lee AH, Ng JQ, Morlet N, Fraser ML (2012). First eye cataract surgery and hospitalization from injuries due to a fall: a population-based study. Journal of the American Geriatrics Society, 60(9), 1730-1733. https://doi.org/10.1111/j.1532-5415.2012.04098.x ; Meuleners LB, Fraser ML, Ng J, Morlet N (2014). The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study. Age and Ageing, 43(3), 341-346. https://doi.org/10.1093/ageing/aft177 ; Keay L, Ho KC, Rogers K, et al. (2022). The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study. Medical Journal of Australia, 217(2), 94-99. https://doi.org/10.5694/mja2.51611 ; 国家卫生健康委 (2022). 「十四五」全国眼健康规划（2021-2025年）. https://www.gov.cn/zhengce/zhengceku/2022-01/17/content_5668951.htm