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Cataract Surgery Does Not Appear to Worsen Age-Related Macular Degeneration

CHICAGO -- November 10, 2009 -- Age-related macular degeneration (AMD) does not appear to progress at a higher rate among individuals who have had surgery to treat cataract, contrary to previous reports that treating one cause of vision loss worsens the other, according to a study published in the November issue of Archives of Ophthalmology.

"Because both conditions are strongly age-related, many individuals with cataract also have AMD," the authors wrote. "There has been a long-standing controversy among clinicians as to whether cataract surgery is contraindicated in eyes with non-neovascular AMD. A major concern has been whether cataract surgery increases the risk of progression to neovascular AMD in eyes at risk of progression such as those with intermediate AMD."

Li Ming Dong, PhD, Stony Brook University School of Medicine, Stony Brook, New York, and colleagues studied eyes of 108 individuals with non-neovascular AMD who underwent preoperative assessments for cataract surgery between 2000 and 2002. Photographs of the retina were taken and fluorescein angiography was performed. A total of 86 evaluated eyes had non-neovascular AMD before surgery, and 71 had follow-up assessments between 1 week and 1 year after surgery.

Neovascular AMD was observed in 9 (12.7%) of these 71 eyes at 1 or more follow-up assessments. Five eyes displayed signs of neovascular AMD at the 1-week follow-up point; the size and location of the lesions identified indicated that they may have been present before surgery but not visible due to the opaque lens caused by cataract.

When these eyes and one eye that did not have 1-week follow-up photographs available were excluded, the progression rate between 1 week and 1 year decreased to 3 of 65 eyes (4.6%). The rate of progression to neovascular AMD was similar among participants' other, cataract-free eyes over the same time period (1 eye, or 3%).

"Our findings suggest that previous reports of the association or progression of non-neovascular AMD to advanced AMD after cataract surgery could be biased with the absence of immediate pre-operative and postoperative fluorescein angiography to rule out pre-existing neovascular AMD or geographic atrophy," the authors wrote.

"Subtle signs of neovascular AMD or geographic atrophy, even on an angiogram, may be obscured by lens opacity just prior to cataract surgery. In such cases, the neovascular disease or the geographic atrophy may contribute to the individual's vision loss, and this may erroneously be ascribed to the cataract and contribute to a decision to proceed with cataract surgery."

"Our findings do not support the hypothesis that cataract surgery accelerates the progression of AMD," they concluded.


SOURCE: Archives of Ophthalmology

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