Impact of Cataract Surgery on Falls Risk in Older Adults: A Systematic Review

Introduction: Falls are a major cause of morbidity, functional decline, and loss of independence in older adults. Visual impairment is a well-recognised and potentially modifiable risk factor for falls, with cataract being the leading cause of reversible visual loss worldwide. Cataract surgery improves visual acuity, contrast sensitivity, and depth perception, all of which are essential for safe mobility. However, evidence regarding the effect of cataract surgery on falls risk in older adults remains inconsistent and has not been comprehensively synthesised. Clarifying this relationship is important to inform falls prevention strategies and to support timely cataract surgery as part of integrated care for older people.

Method: A systematic search was conducted in three electronic databases (PubMed, Embase, and Scopus) for studies published from 2015 to 2025. Eligible studies included randomised controlled trials and observational studies investigating the impact of cataract surgery on falls or fall-related outcomes in adults aged 60 years and older. Only peer-reviewed, full-text articles published in English were included. Following the initial screening of 283 records, 11 studies met the inclusion criteria and were included in the qualitative synthesis.

Results: Most studies reported a reduction in falls following cataract surgery, particularly after first-eye surgery, with some showing further decreases after second-eye surgery. Quasi-experimental and cohort designs consistently indicated lower fall incidence post-surgery compared to pre-surgery or untreated cataract groups. One meta-analysis supported a significant reduction after first-eye surgery but not second-eye. Improved visual acuity and contrast sensitivity were associated with decreased falls. Overall, evidence suggests cataract surgery, especially timely bilateral procedures, mitigates falls risk in older adults with cataracts.

Conclusion: Overall, these findings support the role of cataract surgery in falls prevention and underscore the importance of integrating timely ophthalmic care into geriatric management, while further research is needed to determine optimal timing and long-term effects.