Differences in Cataract Surgery Rates Based on Dementia Status

Article type: Research Article

Authors: Pershing, Suzann^{a; b; *} | Henderson, Victor W.^{c; d} | Bundorf, M. Kate^e | Lu, Ying^f | Rahman, Moshiur^{a; g; h} | Andrews, Chris A.^{g; h} | Goldstein, Mary^{b; i} | Stein, Joshua D.^{g; h}

Affiliations: [a] Byers Eye Institute at Stanford, Palo Alto, CA, USA | [b] VA Palo Alto Health Care System, Palo Alto, CA, USA | [c] Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA | [d] Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA | [e] Department of Health Research and Policy, Stanford University, Stanford, CA, USA | [f] Department of Biomedical Data Science, Stanford University, Stanford, CA, USA | [g] Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA | [h] Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA | [i] Department of Medicine, Stanford University, Palo Alto, CA, USA

Correspondence: [*] Correspondence to: Suzann Pershing, MD, MS, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94304, USA. E-mail: pershing@stanford.edu.

Abstract: Background:Cataract surgery substantially improves patient quality of life. Despite the rising prevalence of dementia in the US, little is known about use of cataract surgery among this group. Objective:To evaluate the relationship between dementia status and cataract surgery. Methods:Using administrative insurance claims for a representative sample of 1,125,387 US Medicare beneficiaries who received eye care between 2006 and 2015, we compared cataract surgery rates between patients with and without dementia via multivariable regression models to adjust for patient characteristics. Main outcome measures were annual rates of cataract surgery and hazard ratio and 95% confidence interval (CI) for receiving cataract surgery. Results:Cataract surgery was performed in 457,128 patients, 23,331 with a prior diagnosis of dementia. 16.7% of dementia patients underwent cataract surgery, compared to 43.8% of patients without dementia. 59 cataract surgeries were performed per 1000 dementia patients annually, versus 105 surgeries per 1000 nondementia patients. After adjusting for patient characteristics, dementia patients were approximately half as likely to receive cataract surgery compared to nondementia patients (adjusted HR = 0.53, 95% CI 0.53–0.54). Among the subset of patients who received a first cataract surgery, those with dementia were also less likely to receive second-eye cataract surgery (adjusted HR = 0.87, 95% CI 0.86–0.88). Conclusion:US Medicare patients with dementia are less likely to undergo cataract surgery than those without dementia. This finding has implications for quality of care and dementia progression. More information is necessary to understand why rates of cataract surgery are lower for these patients, and to identify conditions where benefits of surgery may outweigh risks.

Keywords: Aging and surgery, Alzheimer’s disease, cataract surgery, dementia, eye care, ophthalmology

DOI: 10.3233/JAD-181292

Journal: Journal of Alzheimer's Disease, vol. 69, no. 2, pp. 423-432, 2019