Can eye diseases increase the risk of bone fractures in sufferers? Most likely yes, according to data from a large cohort study, published in Jama Ophthalmology in January 2024, "Risk of falls and fractures in individuals with cataract, age-related macular degeneration', or glaucoma".
The research, based on data from 3,434,196 adult patients suffering from one or more eye diseases, reported the estimated risk of falls or fractures for each disease, using ad hoc multivariate Cox regression models for each. The pathologies examined were cataracts, AMD and glaucoma, present singly or in combination. The result was that persons suffering from one or more of these pathologies had an increased risk of accidental falls and fractures. Fractures could occur in any part of the body, but in particular: spine, hips, forearms, bones of the head and face, pelvis, ribs or sternum, and lower limbs.
In general, the risk of fractures is higher in the elderly, due to the physiological reduction of bone density, the development of osteoporosis, reduced mobility of people, and additional factors, such as being overweight, which is a general risk factor and leads to permanent overloading of the spine and hips. Furthermore, a first fracture may require a long rehabilitation process and be followed by increased dependence on others and loss of self-confidence.
All this results in a further restriction of mobility and a situation of self-isolation that has psychological repercussions. Clinical evidence shows that post-fracture in the elderly is associated with a deterioration of quality of life and increased mortality. Clearly, fractures in the elderly can have a multifactorial aetiology, which includes the presence of other sensory or motor deficits, but the reduced efficiency of visual function seems, however, to play a crucial role.
There was still a lack of a systematic review of the available clinical evidence in this area, and this gap has been partially filled by research that correlated the risk of fractures with the presence of cataracts. The study "Cataract and Risk of Fracture: a Systematic Review, Meta-Analysis, and Bayesian Network Meta-Analysis"Â is a collaboration between the Department of Experimental Medicine at Tor Vergata University in Rome, Moorfield Eye Hospital in London and the American Universities of Boston, Miami and La Jolla, and is being published in Ophthalmology.
This systematic review put together data from 16 studies, 10 prospective and 6 retrospective, published between 1989 and 2023. The patient population considered is very large, more than 4.7 million people, who reported 284,811 fractures. The results show that the risk of fracture is higher in patients with cataracts than in those without, and that the presence of cataracts not only increases the risk but also appears to lead to early fractures over time.
An interesting question the researchers asked themselves was about the variation in fracture risk following intraocular lens implantation. Pseudophakic patients, i.e. with an intraocular lens implant, have by far the lowest risk of fractures compared to phakic patients (i.e. with a natural lens), both with and without cataracts.
The researchers estimated that for every eight patients undergoing cataract surgery, less than one had an expectation of suffering a fracture. This result underlines the importance of opacified lens removal surgery in terms of benefits that extend beyond improved visual function.
These data, for a variety of methodological reasons, are not suitable for supporting a direct causal correlation between cataracts and fractures or for identifying refractive cataract surgery as a strategy for preventing falls and fractures. Therefore, in addition to calling for further rigorous studies and analyses on this topic, the researchers recommend that patients, whether suffering from cataracts or from one or more eye diseases that reduce visual capacity, receive appropriate counselling and, if possible, make use of fall prevention aids and services.
On the topic of cataracts and quality of life see also:
- Cataract surgery improves quality of life - Oculista Italiano
- Cataracts and postoperative dry eye - Oculista Italiano
- Nutraceuticals in cataract prevention - Oculista Italiano
- Afflitto GG, Aiello F, Surico PL et al. Cataract and Risk of Fracture: a Systematic Review, Meta-Analysis, and Bayesian Network Meta-Analysis Ophthalmology, in press, open access
- Gutierrez-Robledo LM, Villasis-Keever, M.A. ∙ Avila-Avila, A. Effect of Cataract Surgery on Frequency of Falls among Older Persons: A Systematic Review and Meta-Analysis J Ophthalmol. 2021; 2021, 2169571
- Tsang JY, Wright A, Carr MJ, et al. Risk of falls and fractures in individuals with cataract, age-related macular degeneration, or glaucoma. JAMA Ophthalmol.Feb 1 2024; 142:96-106