If an older person’s cataracts already affect walking safely, have an eye doctor assess surgery; when both eyes are affected, do not delay the second eye too long

9. If an older person’s cataracts already affect walking safely, have an eye doctor assess surgery; when both eyes are affected, do not delay the second eye too long

Cost: Accompany the older person to ophthalmology once; the doctor decides whether surgery is appropriate. One eye is operated at a time; many hospitals do it as day surgery and send the patient home the same day. If both eyes have cataracts, operate in two separate procedures. Out-of-pocket cost depends on which intraocular lens (artificial lens) you choose and how local yibao reimburses — ask before surgery.

In plain terms: In women aged 70 and older, having the first-eye cataract surgery sooner cut falls over the next year by about one-third, and fewer people fractured bones. The number who fell at least once did not drop. For the second eye, surgery did not show a clear difference in falls. After surgery, hip fracture over one year was about 16% lower.

Benefit: A randomized trial enrolled 306 women aged 70 or older with cataracts. Half had first-eye surgery within about four weeks; half waited 12 months per usual care. Over one year, the early-surgery group had about 34% fewer falls (fall rate ratio 0.66, 95% CI 0.45 to 0.96). At least one fall occurred in 49% of the surgery group versus 45% in the wait group — no reduction. Two or more falls: 18% versus 25%. Fractures: 4 in the surgery group (3%) versus 12 (8%). A Cochrane review included this trial and concluded first-eye surgery in women reduced fall counts; second-eye surgery did not. A randomized trial of the second eye enrolled 239 women aged 70 or older. Fall rates were 32% lower in the surgery group, but the difference could be chance (fall rate ratio 0.68, 95% CI 0.39 to 1.19). In a 5% sample of US Medicare, 1,113,640 cataract patients aged 65 or older (2002–2009) were followed observationally without randomization. After surgery, one-year hip fracture odds were about 16% lower (OR 0.84, 95% CI 0.81 to 0.87). Absolute difference 0.20 percentage points — about 2 fewer cases per 1,000.

Evidence grade: B

Sources: 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 randomized 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 randomized 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>; National Health Commission of China (NHC) (2022). "14th Five-Year Plan" National Eye Health Plan (2021-2025). <https://www.gov.cn/zhengce/zhengceku/2022-01/17/content_5668951.htm>

Notes: Controversy: pooling the two randomized trials, the number who fell at least once did not fall significantly (OR 0.81, 95% CI 0.55 to 1.17). In Western Australian all-population hospital records, hospitalization for fall injury in the year after first-eye surgery rose 27%. Between the two surgeries, such hospitalizations were 2.14 times the pre-surgery rate. Before-after comparisons cannot separate surgery from aging. Another Australian follow-up found the largest drop in fall counts after the second eye. If both eyes have cataracts, do not delay the second too long. Between surgeries, take extra care on stairs and when getting up. A Cochrane-included trial that addressed vision problems in older people actually increased fall counts by about 57%. Surgery fixes vision; preventing falls still needs Section 1, item 13 (balance and leg strength). Whether bones can survive a fall: Section 1, item 39 (bone density screening) and item 40 (treat osteoporosis if found). National eye-health planning states cataract surgery is widely available at county level — not only at big-city hospitals. Main beneficiaries: your parents and grandparents.