The Role of Blue Light-Filtering and Premium Intraocular Lenses on Postoperative Falls: A Nationwide Target Trial Emulation in Taiwan

Abstract

Background: Falls are a leading cause of injury and premature death in older adults, and cataract surgery reduces fall risk. Concerns existed that blue-light filtering (BF) intraocular lenses (IOLs) might impair light transmittance and increase fall risk. We aimed to compare fall incidence and injury diagnoses among patients who received bilateral cataract surgery with premium BF, premium non-BF, and standard non-BF IOLs.

Material and methods: We emulated a target trial by enrolling 26,730 well-matched patients per IOL cohort who underwent bilateral cataract surgeries between 2011 and 2017 from the Taiwan National Health Insurance Research Database. They were followed until a fall, death, withdrawal, or December 31, 2022. Propensity score matching minimized baseline differences across groups.

Results: Fall incidence increased over time, from 9.07 to 21.13 per 1,000 person-years. The premium BF-IOL (12.94) and premium non-BF-IOL (13.12) groups had lower fall rates than the standard non-BF-IOL group (14.85). Both Cox and Fine-Gray models showed significantly lower fall risks for premium BF-IOL (HR 0.86, SHR 0.92) and premium non-BF-IOL (HR 0.88, SHR 0.91) compared to standard IOLs. There was no significant difference in fall risk between premium BF-IOL and premium non-BF-IOL (HR/SHR 0.99). While hospitalization rates post-fall (68.6%) and 30-day fatal fall rate (1.29%) were comparable, standard IOLs were associated with significantly higher fracture rates.

Conclusions: We found no evidence that BF-IOLs increase fall incidence. Both premium IOL groups consistently had lower fall rates than standard non-BF-IOLs, suggesting that socioeconomic factors, in addition to IOL type, may contribute to this reduction.

Keywords: blue light-filtering; cataract surgery; falls; intraocular lens; target trial emulation.