Eyeworld

June 2014 Extending life Another large cohort study, the Blue Mountains Eye Study, 3 evaluated 354 Australians aged 49 years and older who were diagnosed with cataract- related vision impairment—some of whom had undergone surgery and others who had not—and were assessed between 1992 and 2007. Those who had undergone surgery had a 40% lower long-term mortal- ity risk compared to those who did not have surgery. "Correcting cataract patients' vi- sual impairment results in improved outcomes beyond that of the eye and vision, and has important im- pacts on general health," said Jie Jin Wang, PhD, Centre for Vision Research, Westmead, Australia. The association between correc- tion of cataract-related visual impair- ment and reduced mortality risk is not clearly understood, but plausible factors may include improvements in physical and emotional well- being, optimism, greater confidence associated with independent living after vision improvement, as well as greater ability to comply with pre- scription medications, the group noted. Dr. Wang said one limitation of the study is that participants with cataract-related visual impairment who did not have cataract surgery could have had other health prob- lems that prevented them from undergoing surgery and that these other health problems could partly explain the poorer survival among non-surgical participants. Neverthe- less, findings from a larger cataract surgical cohort showed similar sur- vival benefit in patients who have had visual impairment corrected after cataract surgery, compared to patients whose visual impairment persisted after cataract surgery. 4 Vitamins may delay cataract onset The Physicians' Health Study, a cohort of 14,641 middle-aged and older U.S. male physicians, found that daily multivitamin use de- creased the risk of cataract, but did not have a significant effect on visually significant age-related mac- ular degeneration. 5 The randomized, double-masked study was conducted between 1997 and 2011, where half the participants took a common daily multivitamin, and the other half took a placebo. Participants were also randomly assigned to vitamin C, vitamin E, and beta carotene supplements. The researchers found that in the placebo group, 945 cases of cataract developed, which were self- reported and confirmed by medical records, while only 872 cases of cataract developed in the multivita- min group, representing a 9% de- crease in risk. This risk was even lower, at 13%, for nuclear cataract. "If multivitamins do reduce the risk of cataract, even by a modest 10%, this rather small reduction would nonetheless have a large public health impact," said William Christen, ScD, the study's lead author. Multivitamin daily use seemed to have more benefits for older men, but the trend did not reach statisti- cal significance. The study authors added the findings were consistent with results of two other studies conducted outside the U.S. "Long-term daily multivitamin use may have a small to moderate beneficial effect on risk of cataract, particularly nuclear cataract," the authors said. EW References 1. Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: A new economic paradigm. Ophthalmology. 2013;120:2367– 2376. 2. Wittenborn JS, Zhang X, Feagan CW, et al. for the Vision Cost-Effectiveness Study Group. The economic burden of vision loss and eye disorders among the U.S. population younger than 40 years. Ophthalmology. 2013; 120:1728–1735. 3. Fong CS, Mitchell P, Rochtchina E, Teber ET, Hong T, Wang JJ. Correction of visual impair- ment by cataract surgery and improved survival in older persons: The Blue Mountains Eye Study Cohort. Ophthalmology. 2013; 120:1720–1727. 4. Fong, CS, Mitchell P, Rochtchina E, de Loryn T, Tan AG, Wang JJ. Visual impairment corrected via cataract surgery and five-year survival in a prospective cohort. American Journal of Ophthalmology 2014;157:163-170. 5. Christen WG, Glynn RJ, Manson JE, et al. A multivitamin supplement and cataract and age-related macular degeneration in a randomized trial of male physicians. Ophthalmology. 2013, article in press. Editors' note: The sources have no financial interests related to their comments. Contact information Brown: mbrown@valuebasedmedicine.com Christen: wchristen@rics.bwh.harvard.edu Wang: jiejin.wang@sydney.edu.au Benefits continued from page 25 20-31 Cataract_EW June 2014-DL_Layout 1 6/3/14 12:20 PM Page 27

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