Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California (Drs Coleman and Tseng) (firstname.lastname@example.org); and H. Dunbar Hoskins Jr MD Center for Quality Eye Care, American Academy of Ophthalmology, San Francisco, California (Dr Lum).
In Reply: By suggesting that effects of surgery might differ across subgroups, Drs Rao and Dlouhy raise questions about the possibility of age × surgery or comorbidity × surgery interaction effects. In fact, both interaction effects were statistically significant.
However, we do not think a finding of statistically significant interactions should be regarded as airtight evidence that surgery is harmful for certain subgroups. Younger and healthier patients may be more physically active after cataract surgery and thereby increase their fracture risk. Physicians may wish to alert such patients that data show elevated hip fracture rates after cataract surgery, which might lead them to take postsurgical precautions to avoid fractures.1
Coleman AL, Tseng VL, Lum F. Fracture Risk After Cataract Surgery—Reply. JAMA. 2012;308(21):2185. doi:10.1001/jama.2012.13965