October 25, 2011 (Orlando, Florida) — Elderly patients with Alzheimer's disease who have cataracts may benefit from surgery in terms of improved sight, as well as improved interaction with others and lessened depression. These improvements can also ease the burden on caregivers. But, for some, increased postsurgical agitation may occur.
The results of the 4-month Life from Vision in Alzheimer's Disease (VIVA) interventional prospective study were presented here by Brigitte Girard, MD, from Tenon Hospital, Paris, France, at the American Academy of Ophthalmology (AAO) 2011 Annual Meeting.
"The aim of our study was to assess the neuropsychological benefits of cataract surgery among sight-impaired Alzheimer's patients with a debilitating cataract. Our hypothesis was that a debilitating cataract in Alzheimer's patients may increase cognitive disorders or prevent communication," said Dr. Girard.
Dr. Brigitte Girard
Results were assessed at 1 and 3 months after surgery. The main criteria were patient behavior score (Neuropsychiatric Inventory) and burden on the caregiver. Secondary criteria were cognitive scores (Mini-Mental Status, Alzheimer's Disease Assessment Scale), autonomy scores (Instrumental Activities and Autonomy questionnaire), and depression scores (Geriatric Depression Scale, Cornell Scale for Depression in Dementia).
Results that remained stable or improved were considered to be positive outcomes.
Forty-six patients with Alzheimer's disease from geriatric centers around Paris were enrolled. All surgeries were performed at the same hospital. In all, 42 phacoemulsifications and 41 implantations were done. Agitation at the time of surgery was not an issue; 37 patients required only locoregional anesthesia.
The patients were very old (mean age, 86 years; 23 were 85 years or older; 9 were 90 years or older), and the majority (82%) were women.
The results showed that cataract surgery significantly improved visual acuity, improved behavior (especially sleep patterns), and lessened depression, especially in patients with mild dementia. Six of 7 patients improved on these measures. However, agitation and motor behavior increased in some patients.
The postoperative burden on the caregiver improved in 25% but worsened in 25%, principally because of increased patient agitation.
"This first worldwide study about the benefits of cataract surgery in Alzheimer's patients has shown a dramatic improvement in visual acuity. Surgery does not affect a person’s general condition or dementia," said Dr. Girard.
"This is just a fascinating study and I would suspect that the patient outcome would vary, with a patient doing better one day and not so well another day. But this study is a great step in the right direction to prove that we can improve a person’s quality of life even when they have dementia and that a caregiver’s ease of giving care would be improved. It's nice to know that these can occur, at least some of the time," said William Fishkind, MD, director of the Fishkind, Bakewell & Maltzman Eye Care and Surgery Center in Tucson, Arizona.
"This was more of a case-control study, where the patient was their own control. There was no external control group of patients who did not get cataract surgery. If there was such a study I think you would find cataract surgery would win hands-down in helping Alzheimer's patients. Sure, you will see some fluctuation in the patients. But, in the control group, probably all the patients would get worse," said Steven Dewey, MD, from Colorado Springs Health Partners PC.
The study was funded by Assistance Publique-Hôpitaux de Paris. Dr. Girard has disclosed no relevant financial relationships. Dr. Fishkind revealed relationships with Abbott Medical Optics, LensAR, and Thieme Medical Publishers. Dr. Dewey revealed relationships with Abbott Medical Optics and Microsurgical Technology.
American Academy of Ophthalmology (AAO) 2011 Annual Meeting; Abstract #PA085. Presented on October 25, 2011.
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