Cataract Surgery for Patients in Their 90s

Cataract surgery poses no greater risk of ocular complications for patients in their 90s than those in their 80s, according to a recent study of patients treated within the U.S. Veterans Health Administration (VHA).  The study, conducted by Tseng et al from the VA Medical Center, Rhode Island (Ophthalmology 2011), used data from the National Patient Care Database to compare surgical complication rates of 554 nonagenarians and 11,407 octogenarians who received cataract surgery in the VHA.  The authors collected patient demographics and preoperative systemic and ocular comorbidities, and evaluated both intraoperative complications and 90-day postoperative complications. 

A previous study of 45,000 veterans undergoing cataract surgery in the VHA, which evaluated a comprehensive list of comorbidities and ocular complications, found that patients aged >= 80 years were at increased risk for ocular complications after cataract surgery.  This study sought to determine whether patients at the higher end of the age spectrum - those in their 90s - were at greater risk for complications than were patients in their 80s.

For both age groups in this study, diabetes mellitus was the most common systemic comorbidity and age-related macular degeneration the most common ocular cormorbidity.  The study showed that while octogenarians had a higher prevalence of systemic comorbidities overall, nonagenarians were more likely to experience ocular comorbidities.

In both age groups, the most common intraoperative and postoperative complications were vitreous loss or posterior capsular tear and posterior capsular opacification.  The authors noted that within this VHA study population, the risk of having any intraoperative or postoperative complication was 13.5% for octogenarians and 13.4% for nonagenarians.

"This study was not designed to determine criteria for selecting nonagenarians for cataract surgery," the authors wrote.  "However, once the decision has been made to proceed with surgery, [these data] may inform cataract surgeons and their nonagenarian patients regarding the risk of experiencing an ocular complication."  Additional studies are needed to assess how nonagenarians are selected for cataract surgery and to evaluate visual function and quality of life in these patients, the authors added.