Beyond Vision Loss: Understanding the Impact of Cataract on Fall Risk and Health in Older Australians

Abstract

Cataract is a leading cause of vision impairment in the older population. Although cataract surgery can restore sight, it is not uncommon for people in Australia to wait up to three years for first eye surgery; an initial two years for outpatient assessment and a further 12 months on the surgical wait list. The consequences of waiting for surgery encompass physical, mental and social domains, compromising an older person’s quality of life, and limiting active ageing. However data describing these effects in older Australians with cataract are scarce, hindering policy change to support timely care. Cataract also increases fall risk; a significant public health issue in the older population. The benefits of surgery for preventing falls is unclear, as visual mechanisms underlying fall risk in those with cataract are complex. While laboratory studies link blur, spectacle lens magnification, and lens type with impaired balance and mobility, up to now there were limited data from real-world settings. This thesis reports findings from a comprehensive prospective cohort study of fall risk and wellbeing in older adults with bilateral cataract referred to eight Australian public hospitals. It establishes cataract-related falls as an important public health concern and confirms the benefit of first eye cataract surgery for reducing fall risk. The determinants of falls during the wait for first eye surgery are assessed, highlighting greater risk for more active older adults and for those with a history of falls. Cautious refractive management after first eye cataract surgery may maximise the effect of surgery on fall prevention. The research shows a high prevalence of depressive symptoms, associated with greater visual disability and emerging at modest levels of vision loss. The interplay of physical function and visual disability in the presence of fear of falling is explored, reinforcing the importance of taking a holistic approach to the care of an older person with cataract. This thesis enriches the evidence base for policies underpinning the timely, effective management of cataract. By applying the World Health Organization’s policy framework for active ageing, it affirms need for a new policy direction to improve the ability of Australian public health services to support active ageing for those with cataract.