Cataract Surgery, Visual Function, and Neurocognitive Outcomes in Older Adults: A Prospective Monocentric Study

Background: Age-related cataract is the leading cause of reversible vision loss and sensory deprivation in the elderly. Increasing evidences suggest that visual restoration through cataract surgery may influence cognitive performance, emotional state, and circadian regulation. Methods: This prospective observational study included 81 elderly patients (mean age 78 years, 65% female) undergoing phacoemulsification with monofocal intraocular lens (IOL) implantation. Cognitive and psychological assessments were performed at baseline (T0), one month (T1), and six months (T2) postoperatively using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS-15), Perceived Stress Scale (PSS), and Insomnia Severity Index (ISI). Results: Significant improvement in global cognitive performance was observed, with mean MoCA scores increasing from 22.6 at baseline to 25.2 at one month ( p  < .001), and stabilising at six months ( p  = .661). PSS scores showed a significant reduction ( p  = .016), while GDS-15 and ISI demonstrated non-significant but favourable trends. Subdomain analyses revealed significant improvements in visuospatial-executive, attention, abstraction, and delayed recall domains. Regression analyses identified change in best-corrected visual acuity (BCVA), educational level, and absence of neurological comorbidities as independent predictors of cognitive gain ( p  < .05). Conclusions: Cataract surgery contributes not only to improved vision, but also to enhanced cognitive function and stress reduction. These findings reinforce the concept that ophthalmic surgery can play a pivotal role in promoting cognitive resilience and psychological well-being among the elderly population worldwide.