The association of cataract surgery with risk of falls and fractures among medicare enrollees with cataract

Abstract Background Falls and fractures are a significant public health concern linked to visual impairment. Cataracts are the most common cause of visual impairment in older adults and can be corrected with cataract surgery. This study evaluated whether cataract surgery reduces the one-year risk of falls/fractures in Medicare beneficiaries with cataract. Methods Using 2019-2021 claims data from a nationally representative cohort of 940,233 Medicare fee-for-service enrollees (66+ years), we identified those with untreated cataract in 2019 and grouped them into those with and without cataract surgery in 2020. Using the surgery date (surgery group) or a randomly assigned date in 2020 (non-surgery group) as the index date, we identified incident falls/fractures (outpatient, emergency department, or inpatient) during the following 365 days. We used a propensity score-based (with average treatment effect on the treated weights) linear probability regression model to estimate the association of cataract surgery with the risk (likelihood) of falls/fractures, accounting for observed differences between those with and without surgery. Results Without surgery, the estimated likelihood of falls/fractures was 8.86% (95% CI: 8.53-9.18%). Cataract surgery was not associated with a significant difference in the risk of falls/fractures (risk difference= -0.15 percentage points; 95% CI: -1.0, 0.74). Similar findings were observed for subgroups by race and ethnicity, frailty, and fall/fracture history. Conclusions Cataract surgery was not significantly associated with one-year risk of falls/fractures in Medicare beneficiaries. Future studies should evaluate fall risk over a longer follow-up period or the impact of surgery on self-reported falls not captured by the healthcare system.