The Impact of Cataract Surgery Refusal on Depressive Symptoms and Cognitive Function.

Background: This study aimed to compare depressive symptoms and cognitive function between older adults who accepted cataract surgery and those who declined it.

Methods: This cross-sectional observational study was conducted at the Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey. The study included 108 patients aged 60 years or older with bilateral cataracts. The surgery-accepting group consisted of 54 participants, while the surgery-refusing group included 54 participants, matched on a 1:1 basis by age (±2 years), gender and systemic health conditions such as diabetes and hypertension. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15), and cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Exclusion criteria included patients with unilateral cataracts, prior cataract surgery, major neurological disorders (e.g., dementia, Parkinson's disease) or severe psychiatric disorders.

Results: The mean GDS-15 score was 7.33 ± 2.5 in the surgery-refusing group and 5.26 ± 1.47 in the surgery-accepting group (p < 0.001). A significant positive correlation was found between the severity of visual impairment and higher depressive symptoms (p < 0.001), indicating that worse vision is associated with more depressive symptoms. However, no significant difference was observed in MMSE scores between the two groups (23.57 ± 1.34 vs. 23.67 ± 1.33, p = 0.95), suggesting that the refusal of cataract surgery is not directly related to cognitive function.

Conclusions: Refusal of cataract surgery is significantly associated with more depressive symptoms but does not appear to be linked to cognitive function. These findings highlight the importance of addressing psychological factors when discussing surgical options with older adults and emphasise the need for a multidisciplinary approach to improve both visual and mental health outcomes.