The impact of cataract surgery on cognitive impairment and depressive mental status in elderly patients
ABSTRACT To evaluate the influence of cataract surgery on cognitive function and depressive mental status of elderly patients.
Prospective, interventional case series.
The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI) are the measures designed to assess vision-related quality of life (QOL), cognitive impairment, and depressive mental status, respectively. These tests were performed before and two months after surgery in 102 patients undergoing phacoemulsification and intraocular lens implantation for bilateral cataract.
The change in best-corrected visual acuity by surgery significantly correlated with the change in NEI VFQ-25 score (Pearson correlation, r = -0.310; P = .031). The change in NEI VFQ-25 score by surgery significantly correlated with the change in MMSE score (r = 0.306; P = .035) and the change in BDI score (r = -0.414; P < .001). The change in MMSE score showed significant correlation with the change in BDI score (r = -0.434; P < .001).
Vision-related QOL, cognitive impairment, and depressive mental status are all strongly related with each other. Cataract surgery significantly improved vision-related QOL in elderly patients, and cognitive impairment and depressive mental status also improved in parallel with improvement in vision-related QOL.
01/2014; 3(5):267-270. DOI:10.1097/APO.0000000000000033
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ABSTRACT: Blue light information plays an important role in synchronising internal biological rhythm within the external environment. Circadian misalignment is associated with the increased risk of sleep disturbance, obesity, diabetes mellitus, depression, ischaemic heart disease, stroke and cancer. Meanwhile, blue light causes photochemical damage to the retina, and may be associated with age-related macular degeneration (AMD). At present, clear intraocular lenses (IOLs) and blue-blocking IOLs are both widely used for cataract surgery; there is currently a lack of randomised controlled trials to determine whether clear or blue-blocking IOLs should be used. This randomised controlled trial will recruit 1000 cataract patients and randomly allocate them to receive clear IOLs or blue-blocking IOLs in a ratio of 1:1. The primary outcomes are mortality and the incidence of cardiovascular disease, cancer and AMD. Secondary outcomes are fasting plasma glucose, triglycerides, cholesterol, glycated haemoglobin, sleep quality, daytime sleepiness depressive symptoms, light sensitivity, the circadian rhythm of physical activity, wrist skin temperature and urinary melatonin metabolite. Primary outcomes will be followed until 20 years after surgery, and secondary outcomes will be assessed at baseline and 1 year after surgery. Ethical approval has been obtained from the Institutional Review Board of Nara Medical University (No. 13-032). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) home page. UMIN000014680. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.BMJ Open 05/2015; 5(5):e007930. DOI:10.1136/bmjopen-2015-007930 · 2.06 Impact Factor
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ABSTRACT: Light information is the most important cue of circadian rhythm which synchronizes biological rhythm with external environment. Circadian misalignment of biological rhythm and external environment is associated with increased risk of depression, insomnia, obesity, diabetes, cardiovascular disease, and cancer.Increased light transmission by cataract surgery may improve circadian misalignment and related health outcomes. Although some observational studies have shown improvement of depression and insomnia after cataract surgery, randomized controlled trials are lacking. We will conduct a parallel-group, assessor-blinded, simple randomized controlled study comparing a cataract surgery group at three months after surgery with a control group to determine whether cataract surgery improves depressive symptoms, sleep quality, body mass regulation, and glucose and lipid metabolism. We will recruit patients who are aged 60 years and over, scheduled to receive their first cataract surgery, and have grade 2 or higher nuclear opacification as defined by the lens opacities classification system III. Exclusion criteria will be patients with major depression, severe corneal opacity, severe glaucoma, vitreous haemorrhage, proliferative diabetic retinopathy, macular oedema, age-related macular degeneration, and patients needing immediate or combined cataract surgery. After baseline participants will be randomized to two groups. Outcomes will be measured at three months after surgery among the intervention group, and three months after baseline among the control group. We will assess depressive symptoms as a primary outcome, using the short version geriatric depression scale (GDS-15). Secondary outcomes will be subjective and actigraph-measured sleep quality, sleepiness, glycated haemoglobin, fasting plasma glucose and triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, abdominal circumference, circadian rhythms of physical activity and wrist skin temperature, and urinary melatonin metabolite. Chronotype and visual function will be assessed using the 'morningness-eveningness' questionnaire, the Munich chronotype questionnaire, and the National Eye Institute Visual Function Questionnaire. Although there are potential limitations due to the difference in duration from baseline survey to outcome measurements between two groups, any seasonal effect on the outcome measurement will be balanced as a result of continuous inclusion of participants through the year, and outcomes will be adjusted for day length at outcome measurements at analysis.Trial registration: UMIN000014559, UMIN Clinical Trials Registry, registered on 15 July 2014.Trials 12/2014; 15(1):514. DOI:10.1186/1745-6215-15-514 · 2.12 Impact Factor