Bariatric Surgery Reduces Risk of Ocular Disease in Patients with Obesity

Matthew Russell, MD

Credit: Cleveland Clinic

Bariatric surgery may reduce the risk of future ocular morbidity in patients with morbid obesity, according to results from a retrospective cohort study.

Patients who received bariatric surgery experienced a reduction in postoperative ocular disease incidence, including cataract, ocular hypertension, glaucoma, and retinopathy.¹

“Obesity has been implicated as a driver of diabetic retinopathy, glaucoma, and age-related macular degeneration. Bariatric surgery has been found to be efficacious in treatment of morbid obesity,” wrote investigators.¹ “Preliminary studies have shown bariatric surgery may be helpful in management of diabetic retinopathy and intraocular pressure. The effect of bariatric surgery on postoperative ocular disease incidence is largely unknown.”

Obesity is associated with an array of health consequences, including cardiovascular diseases and diabetes. Diseases caused by obesity can lead to serious sight-threatening retinal diseases. Bariatric surgery is used to treat obesity and prevent its related metabolic diseases, although little is known about its impact on ocular disease incidence.^2,3

To examine the association between bariatric surgery and ocular disease states postoperation, Matthew Russell, MD, of the center for ophthalmic bioinformatics at Cleveland Clinic Cole Eye Institute, and colleagues collected data for 42,408 patients with morbid obesity with a procedural code for bariatric surgery from the TriNetX United States Collaborative Network national database and matched them to 42,408 patients with morbid obesity but no surgical history. Cohorts were matched according to age, race, ethnicity, gender, and obesity status.¹

Outcomes of interest included new diagnoses of diabetic retinopathy, age-related macular degeneration, ocular hypertension, glaucoma, cataract, and associated surgeries or disease worsening events.¹

Upon analysis, bariatric surgery was associated with a decreased risk of cataract diagnoses and cataract surgery:

• Age-related cataract (Risk ratio [RR], 0.479; confidence interval [CI], 0.444-0.518; P < .001)
• Nuclear sclerotic cataract (RR, 0.483; CI, 0.444-0.527; P < .001)
• Cortical cataract (RR, 0.451; CI, 0.362-0.563; P < .001)
• Posterior subcapsular cataract (RR, 0.397; CI, 0.296-0.533; P < .001)
• Diabetic cataract (RR, 0.326; CI, 0.274-0.386; P < .001)
• Cataract surgery (RR, 0.524; CI, 0.448-0.612; P < .001)

Investigators noted bariatric surgery was also associated with a decreased risk of ocular hypertension (RR, 0.406; CI, 0.358-0.461; P < .001), glaucoma (RR, 0.466; CI, 0.349-0.622; P < .001), and glaucomatous surgeries (RR, 0.461; CI, 0.34-0.626; P < .001). Additionally, patients who underwent bariatric surgery were at a lower risk of proliferative diabetic retinopathy (RR, 0.453; CI, 0.339-0.604; P < .001), diabetic retinopathy with macular edema (RR, 0.224; CI, 0.17-0.297; P < .001), worsening events, and surgeries (both P < .006).¹

“This study shows bariatric surgery is associated with decreased risk of future ocular morbidity. Specifically, this is the first to show bariatric surgery to result in a reduction in ocular disease states such as diabetic retinopathy, macular degeneration, glaucoma, and cataract in a large US cohort. The associations suggest a need for further investigation of bariatric surgery and obesity reduction on development of ocular morbidity in large long term clinical settings,” investigators concluded.¹

References:

1. Russell M, Kumar M, Li A, et al. Incidence of Ocular Pathology Following Bariatric Surgery for Morbid Obesity Across a Large US National Database. Paper Presented at: American Academy of Ophthalmology 2023. November 3-6, 2023.
2. Lazarus R. Eyes and Obesity. Primary Eye Care. February 18, 2021. Accessed November 17, 2023. https://www.optometrists.org/general-practice-optometry/guide-to-eye-health/eyes-and-nutrition/eyes-and-obesity/
3. Cleveland Clinic. Bariatric Surgery. Treatments & Procedures. June 9, 2022. Accessed November 17, 2023. https://my.clevelandclinic.org/health/treatments/17285-bariatric-obesity-surgery