In High-risk Cataract Surgery, Age is Just a Number

Though the prevalence of ocular comorbidities such as advanced cataract, pseudoexfoliation syndrome, glaucoma and AMD tend to increase with age, experts say that these conditions don’t necessarily lead to a poor outcome or increased surgical risk—when managed appropriately. Photo: Joseph Sowka, OD. Click image to enlarge. Today’s growing elderly patient population not only means increased demand for cataract surgery but also that many more individuals in their 80s and 90s are seeking cataract surgery. While advanced age is often assumed to be a risk factor, it’s still unclear whether age itself is linked to worse outcomes. To answer this question, researchers in Israel and Finland examined a cohort of high-risk cataract patients. Their findings, published recently in Clinical Ophthalmology, suggested that older age shouldn’t be treated as a contraindication for surgery in these patients. The retrospective analysis included 100 patients (75 under age 80; 25 aged 80 or older). The researchers examined factors including operation time, complication rates, postop BCVA and IOP. A secondary analysis focused on links between age and surgical outcomes adjusted for a number of preop risk factors.The two age groups had comparable baseline characteristics, including sex distribution, comorbidities, cataract grade, pseudoexfoliation, BCVA and IOP. None of the patients in the study required vitrectomy.The researchers reported no differences in the rate of intraoperative floppy iris syndrome (IFIS), the use of iris hooks or postop BCVA at week one for the younger and older groups. For patient age at surgery, correlation analysis showed no association with operation time, surgical challenge rate or postop BCVA at week one. The researchers’ multivariable analysis likewise found that patient age at the time of surgery didn’t have a significant effect on operation time when adjusted for pseudoexfoliation and IFIS.Adjusting for wet AMD and glaucoma did reveal that advanced age trended toward worse week-one postop BCVA, with each additional year linked to a 0.01 logMAR decline.Previous studies have reported higher rates of surgical challenges and complications in older patients; however, the authors of this study aver that their “findings reinforce the notion that it is not chronological age per se, but rather the careful preoperative assessment and intraoperative management of age-associated ocular pathology, that determines surgical success. Furthermore, specific preoperative risk factors—not chronological age—should guide surgical risk stratification.”The authors concluded in their paper that an individualized approach to surgical planning for elderly patients is the best route. “Age alone should not be considered a limiting factor,” they wrote. “Rather than using age as a sole criterion for risk, surgeons should rely on a combination of clinical indicators, including lens density, ocular comorbidities and systemic health.”Eyecare providers can assure older patients that though age is linked with increased prevalence of several risk factors, “its independent predictive value appears limited.”Click here for the journal source. Nemet A, Anaki L, Ben Shitrit I, et al. Advanced age does not predispose to intraoperative complications among high-risk cataract surgeries. Clin Ophthalmol 2025;19:3713-3718. [Epub October 6, 2025].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.