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Investigating Sex-Based Differences in Cataract Surgery

Investigating Sex-Based Differences in Cataract Surgery

Although studies show males typically have more comorbidities and seek care later than females, CU ophthalmology researchers say both sexes can expect similar visual outcomes from cataract surgery.

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Written by Kara Mason on March 7, 2024

Men undergoing cataract surgery typically have more pre-operative comorbidities than women and face higher rates of some complications, according to a new study by faculty members in the Department of Ophthalmology at the University of Colorado School of Medicine.

“This research builds the knowledge base for physicians to be able to provide more personalized care based on the sex of the patient,” says Jennifer Patnaik, PhD, assistant professor of ophthalmology, who contributed to the paper published in the International Journal of Ophthalmology earlier this year. “It also helps both the physician and patient to know what they should expect based on the patient’s prior conditions and their gender.”

Researchers also observed that although males have higher rates of some surgical complications, these rates exhibit almost no difference by sex when adjusted for pre-operative differences. In addition, post-operative best corrected visual acuity (BCVA) — or how well the patient’s vision is following the cataract surgery — is similar between sexes.

Breaking down disparity differences

Cataracts account for about 15.2 million cases of blindness and 78.8 million cases of moderate to severe visual impairment worldwide, according to the 2020 Global Burden of Disease Study. While cataract surgery has become commonplace and highly successful for restoring vision, some complications can occur either during or after the operation.

To better understand these complications and why they occur, CU ophthalmology researchers turned their attention to sex disparities. They analyzed data from 7,253 patients treated at the Sue Anschutz-Rodgers Eye Center, looking at demographics, medical history, ocular comorbidities, surgical characteristics, complications, and pre-operative and post-operative visual outcomes by sex.

Male patients presented older for surgery – an expected finding for the researchers, who point out that prior research shows men are typically less likely to seek out health care than women.

Males also had higher rates of comorbidities, or one or more diseases simultaneously present with another. Nearly one-third of male patients had a history of heart disease, compared to about 22% of female patients. Hypertension and type 2 diabetes were also more prevalent among males.

The only comorbidity that was higher for women included in the study was the presence of autoimmune disease.

Studies have previously shown that women are at higher risk of developing cataracts than males, likely due to post-menopausal declining levels of estrogen and a longer life expectancy. In developing countries, women also face lack of health care access.

In the cohort studied by the researchers, males had significantly higher percentages of traumatic cataracts, prior ocular surgery, and mature cataracts. Conversely, females had a significantly higher percentage of pseudoexfoliation, which targets ocular tissue and can raise pressure inside the eye and, in some cases, damage the optic nerve. 

Males were more than twice as likely to experience retinal detachment after the surgery, 0.7% compared to women at 0.3%. Males also experienced cystoid macular edema, a condition in which fluid in the macula causes retinal swelling, at a higher rate, 2.6% compared to 2% in females.

Following surgery, females were slightly more likely to undergo Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO), a laser procedure that if often needed to help with vision after cataract surgery, than men, 13.3% compared to 10.4%.

While overall rates for some complications can be low, it’s still beneficial to know the disparity, Patnaik explains.

“It’s important to know what happens in the cohort without adjustment because sex-based differences are occurring for biological and behavioral reasons,” she says. “Even though men are more likely to have preexisting comorbidities and are more likely to have traumatic cataracts, we want to know whether that causes more problems for men during the surgery, regardless of whether we adjust for those factors.”

Improving outcomes for all patients

Researchers say the study demonstrates important sex differences and similarities for cataract surgery patients in regard to comorbidities at presentation, rates of complications, and visual outcomes.

“Moreover, despite some significant variation in risk factors and complications, patient sex does not significantly affect the primary outcome of post-operative visual acuity,” they conclude.

For patients, the study is reassurance that men and women can expect similar outcomes from cataract surgery, despite men’s likelihood of higher comorbidity rates.

“This research is also a signal to men that they should seek care a little bit earlier, whether that’s for surgery or in their follow-up care,” Patnaik says. “Educating males that it’s encouraged to seek out ophthalmology care is important in getting the best possible outcomes.”

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Jennifer Patnaik, PhD