If an older person's cataract already affects seeing the way, go to an eye doctor for an assessment and surgery; if both eyes have it, don't delay the second one too long

Cost

First take the older person to an eye clinic for one exam, and let the doctor judge whether to operate. One operation per eye, which many hospitals do as day surgery, so they can go home the same day. If both eyes have cataracts, it is done in two operations. How much you pay yourself depends on which artificial lens (intraocular lens) is put in and how local medical insurance reimburses, so ask before the operation.

What you get

One randomized trial recruited 306 women over 70 with cataracts. Half had first-eye surgery within about 4 weeks, and the other half waited the usual 12 months. Over one year, people who had the surgery promptly had about 34% fewer falls. The original value is a fall rate ratio of 0.66, confidence range 95% CI 0.45 to 0.96. The share who fell at least once was 49% in the surgery group and 45% in the waiting group, no fewer. The share who fell twice or more was 18% in the surgery group and 25% in the waiting group. Fractures occurred in 4 people (3%) in the surgery group and 12 (8%) in the waiting group. A Cochrane review included this trial and concluded that first-eye surgery in women reduced the number of falls and second-eye surgery did not. The randomized trial of the second eye recruited 239 women over 70. The surgery group had a 32% lower fall rate, but the difference may be chance (fall rate ratio 0.68, 95% CI 0.39 to 1.19). In a 5% sample of U.S. Medicare, there were 1,113,640 cataract patients over 65 (2002 to 2009). This study only followed records, with no randomized groups. People who had surgery had about 16% lower odds of hip fracture within a year (OR 0.84, 95% CI 0.81 to 0.87). The absolute difference was 0.20 percentage points, about 2 fewer cases per 1,000 people.

Notes

Disputed: when the two randomized trials are pooled, the number of people who fell did not drop clearly (OR 0.81, 95% CI 0.55 to 1.17). In whole-population hospital records from Western Australia, in the year after first-eye surgery there were actually 27% more hospital admissions for fall injuries. In the stretch between the two operations, such admissions were 2.14 times the pre-surgery level. This kind of before-and-after comparison cannot separate the effect of the surgery from the effect of getting older. In another Australian follow-up study, falls dropped most after the second eye was done. So when both eyes have cataracts, don't delay the second too long. Between the two operations, take extra care walking and on stairs. Cochrane also included a trial of helping older people with vision problems, in which falls were actually about 57% higher. Surgery decides whether you can see clearly, and falling less also depends on §1.13 (balance and leg strength). Whether bones can withstand a fall is covered in §1.39 (bone density test) and §1.40 (take medicine if osteoporosis is found). The national eye-health plan (国家眼健康规划) states that cataract vision-restoring surgery is already widely available at the county level, so you do not necessarily need to go to a hospital in a big city. The beneficiaries are mainly your parents and grandparents.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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

Translated from the Chinese original. Original book, section 17, tip 9. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer