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The effect of cataract surgery on neuropsychological test performance: A randomized controlled trial



Recent cross-sectional studies have reported strong associations between visual and cognitive function, and longitudinal studies have shown relationships between visual and cognitive decline in late life. Improvement in cognitive performance after cataract surgery has been reported in patients with Mild Cognitive Impairment. We investigated whether improving visual function with cataract surgery would improve neuropsychological performance in healthy older adults. A randomized clinical trial of cataract surgery performed at acute hospitals was conducted on 56 patients (mean age 73) with bilateral cataract, after excluding a total of 54 patients at the screening stage, of whom 53 did not meet visual acuity criteria and one did not have cataract. In-home assessments included visual and neuropsychological function, computerized cognitive testing and health questionnaires. Results showed no cognitive benefits of cataract surgery in cognitively normal adults. We conclude that visual improvement following cataract surgery is not strongly associated with an improvement in neuropsychological test performance in otherwise healthy adults. Joint associations between visual and cognitive function in late life are likely to be due to central factors, and unlikely to be strongly related to eye disease. Short-term increased neural stimulation from improved visual function does not appear to affect cognitive performance. (JINS, 2006, 12, 632–639.)


Corresponding author

Correspondence and reprint requests to: Kaarin J. Anstey Ph.D., Aging Research Unit, Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia. E-mail:


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AIHW. (2005). Vision problems among older Australians. Canberra: Australian Institute of Health and Welfare.
Anstey, K.J., Butterworth, P., Borzycki, M., & Andrews, S. (2006). Between and within individual effects of visual contrast sensitivity on perceptual matching, processing speed and associative memory in older adults. Gerontology, 52, 124130.
Anstey, K.J., Dain, S., Andrews, S., & Drobny, J. (2002). Visual abilities in older adults explain age-differences in Stroop and fluid intelligence but not face recognition: Implications for the vision-cognition connection. Aging Neuropsychology and Cognition, 9, 253265.
Anstey, K.J., Dear, K., Christensen, H., & Jorm, A.F. (2005). Biomarkers, health, lifestyle and demographic variables as correlates of reaction time performance in early, middle and late adulthood. Quarterly Journal of Experimental Psychology, 58A, 521.
Anstey, K.J., Hofer, S.M., & Luszcz, M.A. (2003). A latent growth curve analysis of late-life sensory and cognitive function over 8 years: Evidence for specific and common factors underlying change. Psychology and Aging, 18, 714726.
Anstey, K.J. & Luszcz, M.A. (2002). Selective non-response to clinical assessment in the longitudinal study of aging: Implications for estimating population levels of cognitive function and dementia. International Journal of Geriatric Psychiatry, 17, 704709.
Anstey, K.J., Luszcz, M.A., & Sanchez, L. (2001). Two-year decline in vision but not hearing is associated with memory decline in very old adults in a population-based sample. Gerontology, 47, 289293.
Anstey, K.J. & Smith, G.A. (1999). Interrelationships among biological markers of aging, health, activity, acculturation, and cognitive performance in late adulthood. Psychology and Aging, 14, 605618.
Bäckman, L. & Forsell, Y. (1994). Episodic memory functioning in a community-based sample of old adults with major depression: Utilization of cognitive support. Journal of Abnormal Psychology, 103, 361370.
Ball, K., Berch, D.B., Helmers, K.F., Jobe, J.B., Leveck, M.D., Marsiske, M., Morris, J.N., Rebok, G.W., Smith, D.M., Tennstedt, S.L., Unverzagt, F.W., & Willis, S.L. (2002). Effects of cognitive training interventions with older adults: A randomized controlled trial. JAMA, 288, 22712281.
Benton-Sivan, A. (1992). The Benton Visual Retention Test (5th ed.). New York: Psychological Corporation.
Christensen, H., Mackinnon, A.J., Korten, A., & Jorm, A.F. (2001). The “common cause hypothesis” of cognitive aging: Evidence for not only a common factor but also specific associations of age with vision and grip strength in a cross-sectional analysis. Psychology and Aging, 16, 588599.
Congdon, N., Vingerling, J.R., Klein, B.E., West, S., Friedman, D.S., Kempen, J., O'Colmain, B., Wu, S.Y., Taylor, H.R., & Eye Diseases Prevalence Research Group. (2004). Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Archives of Ophthalmology, 122, 487494.
Dickinson, C.M. & Rabbitt, P.M.A. (1991). Simulated visual impairment: Effects on text comprehension and reading speed. Clinical Vision Science, 6, 301308.
Drobny, J., Anstey, K.J., & Andrews, S. (2005). Visual memory testing in older adults with age-related visual decline: A measure of memory or visual functioning? Journal of Clinical and Experimental Neuropsychology, 27, 425435.
Elliott, D.B., Patla, A.E., Furniss, M., & Adkin, A. (2000). Improvements in clinical and functional vision and quality of life after second eye cataract surgery. Optometry and Vision Science, 77, 1324.
Erixon-Lindroth, N., Farde, L., Wahlin, T.-B.R., Sovago, J., Halldin, C., & Bäckman, L. (2005). The role of the striatal dopamine transporter in cognitive aging. Psychiatry Research: Neuroimaging, 138, 112.
Ferraro, F.R., Bang, B.J., & Scheuler, K. (2002a). Visual degradation in Boston Naming Test performance. Perceptual and Motor Skills, 95, 11151118.
Ferraro, F.R., Grossman, J., Bren, A., & Hoverson, A. (2002b). Effects of orientation on Rey Complex Figure performance. Brain and Cognition, 50, 139144.
Harwood, R.H., Foss, A.J., Osborn, F., Gregson, R.M., Zaman, A., & Masud, T. (2005). Falls and health status in elderly women following first eye cataract surgery: A randomised controlled trial. British Journal of Ophthalmology, 89, 5359.
Hofer, S.M. & Sliwinski, M.J. (2001). Understanding ageing. An evaluation of research designs for assessing the interdependence of ageing-related changes. Gerontology, 47, 341352.
Horn, J.L. (1982). The aging of human abilities. In B.B. Wolman (Ed.), Handbook of developmental psychology (pp. 847869). Englewood Cliffs, NJ: Prentice-Hall.
Hultsch, D.F., Hertzog, C., Small, B.J., & Dixon, R.A. (1999). Use it or lose it: Engaged lifestyle as a buffer of cognitive decline in aging? Psychology and Aging, 14, 245263.
Li, S.C., Lindenberger, U., & Sikstrom, S. (2001). Aging cognition: From neuromodulation to representation. Trends in Cognitive Science, 5, 479486.
Lindenberger, U. & Baltes, P.B. (1994). Sensory functioning and intelligence in old age: A strong connection. Psychology and Aging, 9, 339355.
Lindenberger, U. & Potter, U. (1998). The complex nature of unique and shared effects in hierarchical linear regression: Implications for developmental psychology. Psychological Methods, 3, 218230.
Lindenberger, U., Scherer, H., & Baltes, P.B. (2001). The strong connection between sensory and cognitive performance in old age: Not due to sensory acuity reductions operating during cognitive assessment. Psychology and Aging, 16, 196205.
Lindenberger, U., Singer, T., & Baltes, P.B. (2002). Longitudinal selectivity in aging populations: Separating mortality-associated versus experimental components in the Berlin Aging Study (BASE). Journals of Gerontology, Series B, Psychological Sciences and Social Sciences, 57, P474482.
Lundstrom, M., Stenevi, U., & Thorburn, W. (2001). Quality of life after first- and second-eye cataract surgery: Five-year data collected by the Swedish national cataract register. Journal of Cataract and Refractive Surgery, 27, 15531559.
Raven, J.C. (1940). Matrix tests. Mental Health, 1, 1018.
Salthouse, T.A. (1994). Aging associations: Influence of speed on adult age differences in associative learning. Journal of Experimental Psychology. Learning, Memory, and Cognition, 20, 14861503.
Salthouse, T.A., Hancock, H.E., Meinz, E.J., & Hambrick, D.Z. (1996). Interrelations of age, visual acuity, and cognitive functioning. Journals of Gerontology, Series B, Psychological Sciences and Social Sciences, 51, P317330.
Schneider, B. & Pichora-Fuller, M. (2000). Implications of perceptual deterioration for cognitive ageing research. In The handbook of aging and cognition. Mahwah, NJ: Erlbaum.
Tamura, H., Tsukamoto, H., Mukai, S., Kato, T., Minamoto, A., Ohno, Y., Yamashita, H., & Mishima, H.K. (2004). Improvement in cognitive impairment after cataract surgery in elderly patients. Journal of Cataract and Refractive Surgery, 30, 598602.
Valentijn, S.A., van Boxtel, M.P., van Hooren, S.A., Bosma, H., Beckers, H.J., Ponds, R.W., & Jolles, J. (2005). Change in sensory functioning predicts change in cognitive functioning: Results from a 6-year follow-up in the Maastricht aging study. Journal of the American Geriatrics Society, 53, 374380.
van Boxtel, M.P., ten Tusscher, M.P., Metsemakers, J.F., Willems, B., & Jolles, J. (2001). Visual determinants of reduced performance on the Stroop color-word test in normal aging individuals. Journal of Clinical and Experimental Neuropsychology, 23, 620627.
von Gunten, A., Giannakopoulos, P., Bouras, C., & Hof, P.R. (2004). Neuropathological changes in visuospatial systems in Alzheimer's disease. In Vision in Alzheimer's disease (pp. 3061). Basel: Karger.
Warrington, E.K. (1984). Recognition Memory Test. Windsor, UK: NFER-Nelson.
Wechsler, D. (1981). Wechsler Adult Intelligence Scale–Revised manual. New York: Psychological Corporation.
Witkovsky, P. (2004). Dopamine and retinal function. Documenta Ophthalmologica, 108, 1740.


The effect of cataract surgery on neuropsychological test performance: A randomized controlled trial



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