The Impact of Cataract Surgery on Depression in Elderly Iranian Patients: A Case–Control Study


Background: Cataract-related vision impairment is clearly associated with depressive symptoms in old age. This study aimed to evaluate the effect of cataract surgery on depression among elderly Iranian patients.

Methods: In this case–control study, a total of 113 elderly patients with and without cataract who were admitted to Buali-Sina Hospital in Sari, Mazandaran, Iran were evaluated. Ophthalmological examinations were first performed at the beginning of the study and then four months later; demographic and clinical characteristics were obtained for all patients. Additionally, depression was assessed using the Hospital Anxiety and Depression Scale (HADS) for all patients during the study period.

Results: A statistically significant difference was found between the mean depression score in patients without cataract (3.28), patients with cataract surgery (3.74), and patients without cataract surgery (5.60) (P = 0.024). On the other hand, there was no statistically significant differences between the mean depression score in patients with cataract surgery and patients without cataract (P = 0.582). However, a statistically significant difference was observed between the mean depression score after cataract surgery in men (1.70) and women (4.94) (P < 0.001). Visual function improved in all bilateral cataract patients who had surgery in one eye. Also, the results of this study showed that in all unilateral cataract patients who had eye surgery, visual function in the left and right eyes improved.

Conclusion: We conclude that depression is more prevalent in patients with cataract compared to those without cataract. In addition, cataract surgery seems to be associated with reduced depression and better visual acuity in elderly patients with cataract.


depressive disorder, cataract, cataract extraction, aged

[1] Ackland, P., Resnikoff, S., and Bourne, R. (2017). World blindness and visual impairment: despite many successes, the problem is growing. Community Eye Health Journal, vol. 30, no. 100, pp. 71–73.

[2] Liu, Y. C., Wilkins, M., Kim, T., et al. (2017). Cataracts. The Lancet, vol. 5, no. 390, pp. 600–612.

[3] Schein, O. D., Cassard, S. D., Tielsch, J. M., et al. (2012). Cataract surgery among Medicare beneficiaries. Ophthalmic Epidemiology, vol. 19, no. 5, pp. 257–264.

[4] Allen, D. and Vasavada, A. (2006) Cataract and surgery for cataract. The BMJ, vol. 333, no. 7559, pp. 128–132.

[5] Tabin, G., Chen, M., and Espandar, L. (2008). Cataract surgery for the developing world. Current Opinion in Ophthalmology, vol. 19, no. 1, pp. 55–59.

[6] Davis, G. (2016). The evolution of cataract surgery. Missouri Medicine, vol. 113, no. 1, pp. 58–62.

[7] Ashwin, P. T., Shah, S., Wolffsohn, J. S. (2009). Advances in cataract surgery. Clinical and Experimental Optometry, vol. 92, no. 4, pp. 333–342.

[8] Ho, J. W. and Afshari, N. A. (2015). Advances in cataract surgery: preserving the corneal endothelium. Current Opinion in Ophthalmology, vol. 26, no. 1, pp. 22–27.

[9] Skalicky, S. E., Martin, K. R., Fenwick, E., et al. (2015). Cataract and quality of life in patients with glaucoma. Clinical & Experimental Ophthalmology, vol. 43, no. 4, pp. 335–341.

[10] Palagyi, A., Rogers, K., Meuleners, L., et al. (2016). Depressive symptoms in older adults awaiting cataract surgery. Clinical & Experimental Ophthalmology, vol. 44, no. 9, pp. 789–796.

[11] Safiri, S. and Ayubi, E. (2017). Depressive symptoms in older adults awaiting cataract surgery: methodological and statistical issues. Clinical & Experimental Ophthalmology, vol. 45, no. 8, pp. 840–841.

[12] Alexopoulos, G. S. (2005). Depression in the elderly. The Lancet, vol. 365, no. 9475, pp. 1961–1970.

[13] Barua, A., Ghosh, M. K., Kar, N., et al. (2011). Prevalence of depressive disorders in the elderly. Annals of Saudi Medicine, vol. 31, no. 6, pp. 620–624.

[14] Fiske, A., Wetherell, J. L., and Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, vol. 5, pp. 363–389.

[15] Eramudugolla, R., Wood, J., and Anstey, K. J. (2013). Co-morbidity of depression and anxiety in common age-related eye diseases: a population-based study of 662 adults. Frontiers in Aging Neuroscience, vol. 5, no. 56, pp. 1–9.

[16] Samarai, V. and Aidenlou, N. S. (2016). A survey on the level of depression in cataract patients hospitalized in urmia. Research Journal of Medical Sciences, vol. 10, no. 4, pp. 282–286.

[17] Pellegrini, M., Bernabei, F., Schiavi, C., et al. (2020). Impact of cataract surgery on depression and cognitive function: systematic review and meta-analysis. Clinical & Experimental Ophthalmology, vol. 48, no. 5, pp. 593–601.

[18] Kheirkhah, F., Roustaei, G., Mohebbi Abivardi, E., et al. (2018). Improvement in cognitive status and depressive symptoms three months after cataract surgery. Caspian Journal of Internal Medicine, vol. 9, no, 4, pp. 386–392.

[19] Miyata, K., Yoshikawa, T., Morikawa, M., et al. (2018). Effect of cataract surgery on cognitive function in elderly: results of Fujiwara-kyo Eye Study. PLoS One, vol. 13, no. 2, p. e0192677.

[20] Ishii, K., Kabata, T., and Oshika, T. (2008). The impact of cataract surgery on cognitive impairment and depressive mental status in elderly patients. American Journal of Ophthalmology, vol. 146, no. 3, pp. 404–409.

[21] McGwin Jr., G., Li, J., McNeal, S., et al. (2003). The impact of cataract surgery on depression among older adults. Ophthalmic Epidemiology, vol. 10, no. 5, pp. 303–313.

[22] Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, vol. 67, no. 6, pp. 361–370.

[23] Montazeri, A., Vahdaninia, M., Ebrahimi, M., et al. (2003). The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health and Quality of Life Outcomes, vol. 1, no. 14, pp.1–5.

[24] Polack, S., Eusebio, C., Mathenge, W., et al. (2010). The impact of cataract surgery on health related quality of life in Kenya, the Philippines, and Bangladesh. Ophthalmic Epidemiology, vol. 17, no. 6, pp. 387–399.

[25] To, K. G., Meuleners, L. B., Fraser, M. L., et al. (2014). The impact of cataract surgery on depressive symptoms for bilateral cataract patients in Ho Chi Minh City, Vietnam. International Psychogeriatrics, vol. 26, no. 2, pp. 307–313.

[26] Berle, D., Steel, Z., Essue, B. M., et al. (2017). Multisite prospective investigation of psychological outcomes following cataract surgery in Vietnam. BMJ Glob Health, vol. 2, no. 1, p. e000162.

[27] Meuleners, L. B., Agramunt, S., Ng, J. Q., et al. (2015). The Cataract Extraction and Driving Ability Research Study Protocol: characterisation of deficits in driving performance and self-regulation among older drivers with bilateral cataract. Injury Prevention, vol. 21, no. 6, pp. 424–429.

[28] Franks, F. and Faux, S. A. (1990). Depression, stress, mastery, and social resources in four ethnocultural women's groups. Research in Nursing & Health, vol. 13, no. 5, pp. 283–292.

[29] Freeman, E. E., Gresset, J., Djafari, F., et al. (2009). Cataract-related vision loss and depression in a cohort of patients awaiting cataract surgery. Canadian Journal of Ophthalmology, vol. 44, no. 2, pp. 171–176.

[30] Owsley, C., McGwin Jr., G., Scilley, K., et al. (2007). Impact of cataract surgery on health-related quality of life in nursing home residents. British Journal of Ophthalmology, vol. 91, no. 10, pp. 1359–1363.

[31] Ghaemmohamadi, M. S., Behzadifar, M., Ghashghaee, A., et al. (2018). Prevalence of depression in cardiovascular patients in Iran: a systematic review and meta-analysis from 2000 to 2017. Journal of Affective Disorders, vol. 227, pp. 149–155.

[32] Ghadirian, L. and Sayarifard, A. (2019). Depression literacy in urban and suburban residents of Tehran, the capital of Iran; recognition, help seeking and stigmatizing attitude and the predicting factors. International Journal of Preventive Medicine, vol. 10, no. 134, pp. 1–6.

[33] Choi, H. G., Lee, M. J., and Lee, S. M. (2018). Visual impairment and risk of depression: a longitudinal follow-up study using a national sample cohort. Scientific Reports, vol. 8, no. 1, p. 2083.

[34] Ribeiro, M. V., Hasten-Reiter Júnior, H. N., Ribeiro, E. A., et al. (2015). Association between visual impairment and depression in the elderly: a systematic review. Arquivos Brasileiros de Oftalmologia, vol. 78, no. 3, pp. 197–201.

[35] Swenor, B. K., Wang, J., Varadaraj, V., et al. (2019). Vision impairment and cognitive outcomes in older adults: the Health ABC Study. The Journals of Gerontology. Series A, Biological Sciences, vol. 74, no. 9, pp. 1454–1460.

[36] Heesterbeek, T. J., van der Aa, H. P. A., van Rens, G., et al. (2017). The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: a longitudinal prospective cohort study. Ophthalmic and Physiological Optics, vol. 37, no. 4, pp. 385–398.

[37] Jefferis, J. M., Clarke, M. P., and Taylor, J. P. (2015). Effect of cataract surgery on cognition, mood, and visual hallucinations in older adults. Journal of Cataract & Refractive Surgery, vol. 41, no. 6, pp. 1241–1247.

[38] Miyata, K., Obayashi, K., Saeki, K., et al. (2016). Higher cognitive function in elderly individuals with previous cataract surgery: cross-sectional association independent of visual acuity in the HEIJO-KYO cohort. Rejuvenation Research, vol. 19, no. 3, pp. 239–243.

[39] Jefferis, J. M., Taylor, J. P., Clarke, M. P. (2015). Does cognitive impairment influence outcomes from cataract surgery? Results from a 1-year follow-up cohort study. British Journal of Ophthalmology, vol. 99, no. 3, pp. 412–417.

[40] Hall, T. A., McGwin Jr., G., and Owsley, C. (2005). Effect of cataract surgery on cognitive function in older adults. Journal of the American Geriatrics Society, vol. 53, no. 12, pp. 2140–2144.