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March de Ribot, A. March de Ribot, J. Benitez del Castillo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "March de Ribot" "email" => array:1 [ 0 => "March.professor@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "March de Ribot" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Benitez del Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Universitario de Girona, Girona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Clínico San Carlos de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implicaciones de la cirugía de catarata para prevenir la demencia en España" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Resources allocation in ophthalmology</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ophthalmology is the second busiest specialty in clinics and theatres (after traumatology). Spain performs 450,247 cataract surgeries annually, but still, the structural surgical waitlist for cataracts is 113,925 patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The average waiting time from specialist assessment to treatment is 64.3 days, but some of these patients have to wait for more than six months, approximately a 12%,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which has significant clinical implications, including cognitive deterioration. We have evidence that cataract surgery can reduce the risk of dementia, so offering this treatment on time is of crucial clinical importance.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The public health system has been affected in the last few years by COVID, and in the near future, we expect an economic recession. With limited public resources available, it is critical to discuss their distribution allocation, and ophthalmology is one of the areas with more repercussions. Vision is essential for 80% of environmental interactions and has profound implications for the life and health of patients. Patients with low vision have a higher risk of mortality and morbidity, an increased 1.5–2 times risk of falls and accidents, 4–8 times the risk of hip fracture, 3.5 times risk of depression and cognitive deterioration.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Nowadays, we have more evidence of the relationship with dementia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Dementia in Spain</span><p id="par0015" class="elsevierStylePara elsevierViewall">In Spain, 20% of the population is older than 65 years, with a life expectancy of 82.3 years. More than 700,000 people have dementia, representing 1.5% of the total population and 7,3% over 65 years, with an estimated two million people in 2050.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The prevalence of dementia increases with age, 0.05% among people aged 40–65; 1.07% between 65–69 years; 3.4% in the 70–74 years; 6.9% in the 75–79 years; 12.1% in the 80–84; 20.1 in 85–89; and 39.2% among those over 90 years of age.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We expect a significant dementia increase for the aging population and risk factors in the next few years. Unfortunately, there are no accurate numbers of people diagnosed with dementia, making it challenging to determine resources, services, supports, solutions and treatments for patients and their families.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This is a big issue because there is no cure for dementia, and nonpharmacologic and pharmacologic therapies, only offer limited improvement.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Cataract surgery reducing dementia</span><p id="par0025" class="elsevierStylePara elsevierViewall">In a recent publication, Lee studied prospectively 3038 adults 65 years or older with cataracts and followed up until the development of dementia. The patients that received cataract surgery had 30% less risk of dementia for 10 years after considering different factors.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The study has significant limitations, and the outcomes must be replicated and discussed. Nevertheless, these results have substantial implications for the care of older people, showing the improved quality of life with cataract surgery and avoiding cognitive deterioration.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cataract surgery can improve dementia symptoms by enhancing visual acuity and secondary visuospatial orientation-related dementia test results. Additionally, after cataract surgery, persons with dementia and poor vision frequently lead more active lifestyles. Patients before and after cognitive impairment may gain both short and long-term. Patients’ visual function must be evaluated, and cataract surgery should be considered when necessary to decrease the risk of dementia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It is crucial to conduct additional studies on the subject, assess big data, and develop cost analysis scenarios when taking the advantages of cataract surgery into account, especially in dementia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Spanish Ministry of Health works with a Comprehensive Plan for Alzheimer's and other Dementias, articulating responses to this challenge of public health and social and health priority. The aim is to face the social and health challenge of dementia to improve the care and support required.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> There is a lot of work to prevent dementia because 40% are preventable considering 12 factors: correcting sensory impairments, having social connections, good education, regular physical activity, reducing obesity and diabetes, BP control, reducing air pollution, preventing head injury, limiting alcohol, and avoiding smoking.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Furthermore, it is considered that 1.8% of dementia cases are associated with vision impairment,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> being the cataract a crucial factor.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> So, with this information, we have more reasons to promote cataract surgery in older people with dementia risk. From the public healthcare perspective, the cost of the operation is minimal compared with the costs of dementia. The average cost of caring for a person with dementia is 31,890 euros<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>; the direct costs of the disease account for almost a quarter of it, including diagnostic tests, medical visits, hospitalizations, medications and long-term care at home or in residence. The rest of the costs are indirect, including the care of caregivers; in 80% of cases, their families.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As a conclusion, cataract surgery on time is a very efficient option for our patients to improve vision and facilitate an independent life, better care, and fewer care costs. We have evidence that cataract surgery can decrease the risk of dementia, so offering surgery on time have significant clinical implications. Furthermore, public authorities must be aware of the importance of cataract surgery to benefit patients and communities for prioritization and resource allocation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Resources allocation in ophthalmology" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Dementia in Spain" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Cataract surgery reducing dementia" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Sistema de Información de listas de espera del SNS (SISLE-SNS) RD 605/2003, Secretaría General de Salud Digital, Información e Ínnovación del SNS — S.G.Información Sanitaria. 2021. 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Vol. 98. Issue 12.
Pages 671-672 (December 2023)
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Vol. 98. Issue 12.
Pages 671-672 (December 2023)
Editorial
Implications of cataract surgery to prevent dementia in Spain
Implicaciones de la cirugía de catarata para prevenir la demencia en España
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