Joint association of postoperative visual acuity status and baseline loneliness with cognitive impairment after cataract surgery in older adults: a retrospective cohort study.

Authors

Xiaoman Liu, Haixia Ji, Xiaohong Jin

Published in

Frontiers in medicine. Volume 13. Pages 1948093. Epub Sep 15, 2026.

Abstract

Evidence on the joint relationship of postoperative visual acuity and loneliness with cognition after cataract surgery remains limited. This study examined whether postoperative visual acuity status and loneliness were jointly associated with cognitive impairment in older patients with age-related cataract.
This single-center retrospective cohort study included patients aged 65 years or older who underwent cataract surgery. Four groups were defined by postoperative best-corrected visual acuity (BCVA) status and baseline loneliness measured with the University of California, Los Angeles (UCLA) Loneliness Scale. Cognitive impairment at 6 months was assessed using the education-adjusted Montreal Cognitive Assessment (MoCA). Multivariable logistic regression, interaction analyses, and Firth penalized logistic regression were used.
Among 377 patients, 79 (21.0%) had cognitive impairment. The proportions across the four groups were 4.9%, 18.3%, 7.4%, and 69.7%. Using good postoperative BCVA without loneliness as the reference, adjusted odds ratios were 5.39 [95% confidence interval (CI), 1.91-16.22] for good BCVA with loneliness, 1.85 (95% CI, 0.48-6.60) for poor BCVA without loneliness, and 88.50 (95% CI, 27.43-338.63) for poor BCVA with loneliness. Positive interaction was observed on multiplicative and additive scales. Firth regression reduced the estimate for the dual-exposure group to 62.18 (95% CI, 20.67-218.82) without altering the overall pattern. Higher UCLA scores were associated with greater MoCA decline (r = -0.503, P < 0.001).
Baseline loneliness was associated with higher odds of cognitive impairment, particularly among patients with poor postoperative BCVA. The large effect estimates and exploratory interaction findings should be interpreted cautiously and require confirmation in larger prospective cohorts.

PMID:
42812269
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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