Cataract Surgery In Patients With Dementia: A 10-Year Real-World Cohort Study At A Uk Tertiary Eye Centre

For patients with dementia, cataracts are a major treatable cause of vision loss and are themselves a recognised modifiable risk factor for dementia. Yet most literature addresses cataract surgery as prevention against incident dementia rather than management of those who already have the disease. These patients present with high surgical complexity including advanced cataracts, ocular comorbidity, and cooperation challenges requiring sedation or general anaesthesia. We report the largest UK cohort study of cataract surgery in patients with established dementia conducted over a decade, characterising visual outcomes, surgical safety, anaesthetic trends, referral-to-surgery waiting times, post-operative follow-up, and equity of access.

Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom, across all network sites. Data were extracted from the electronic patient record (EPR) and Patient Administration System (PAS) for all adult patients with a documented dementia diagnosis who underwent phacoemulsification cataract surgery between April 2015 and December 2025. 

Retrospective observational cohort study using routinely collected data. The primary outcome was change in ETDRS letter score between the pre-operative measurement closest to surgery (within 180 days) and the first post-operative measurement between 14 and 112 days after surgery. Count fingers, hand movements, and light perception were assigned ETDRS equivalents of 5, 3, and 1 letters respectively. Intraoperative complications were ascertained from the CataractComplication EPR field. Care home residency was inferred from address data. Anaesthetic modality, consent type, and post-operative did-not-attend (DNA) rates were analysed over time.  

1,638 procedures in 1,114 patients (mean age 79.7, SD 7.4; 56.8% female). Pre-operative VA was poor (mean 52.6 ETDRS; 60.9% below 6/12). Paired ETDRS data were available for 1,255 eyes, showing mean improvement of +20.0 letters (SD 21.6); 83.5% gained vision, 55.5% gained ≥15 letters, consistent across all age groups including ≥90 years (+17.9 letters). Case-mix complexity was high and rose over the decade: mean predicted PCR risk 3.5% (vs national 1.1%), brunescent cataracts 23.3%, and 26.7% requiring sedation or GA - a sevenfold increase from 4.3% to 30.1%. The observed PCR rate of 2.9% was within expected limits for this complexity. Care home patients (6.7%) did not differ in complication rate (5.5% vs 6.0%) or DNA rate (0.78 vs 0.86).

For patients with dementia, cataract surgery delivers clinically significant visual improvement across all age groups, with over four-fifths of eyes gaining vision and more than half achieving a gain of ≥15 ETDRS letters. The PCR rate must be interpreted in the context of substantial and increasing case-mix complexity (mean predicted risk 3.5%). The poor presenting vision underscores the need for proactive vision screening in all dementia care settings. Care home patients are not a higher-risk group for complications or follow-up failure. Dementia-specific pathways with appropriate anaesthetic support, capacity assessment, and strategies to address ethnic disparities in follow-up are needed to ensure equitable access.