Cataract Surgery and Progression of AMD

There has been a concern that the removal of a cataract may hasten the progression of age-related macular degeneration. Ophthalmologists see a large number of patients who have severe AMD soon after cataract surgery. The combined data from two large studies, the Beaver Dam Eye Study and the Blue Mountain Eye Study, found that AMD developed more often in eyes that had cataract surgery compared to eyes that did not. Both of these studies however didn’t study the retina before the cataract surgery.

Another explanation is that these patients already had AMD when they went to their doctor complaining of poor vision. They also had a cataract making it difficult for the doctor to examine the macula thoroughly. The doctor blamed the cataract for the poor vision and removed it only to find AMD in the retina. In these patients, the AMD caused the cataract surgery, so to speak, not the other way around.

Frederick Ferris reported the results of an analysis of patients in the Age-Related Eye Disease Study (AREDS) at a retinal subspecialty meeting before the American Academy of Ophthalmology Meeting in Chicago. The advantage of AREDS was that the macula was closely examined and photographed before the cataract surgery. During a follow-up of six years, 19% of the patients in AREDS had cataract surgery. There was not an increased risk of developing severe AMD in the patients who had cataract surgery compared to those who did not. Therefore it appears that cataract surgery does not increase the progression of AMD.

So, for patients with AMD, if your doctor feels that removing your cataract would improve your visual function, you can go ahead with the surgery if you wish without the fear that it will make your AMD worse.

References:

1. Wang, JJ, Klein R, Smith W, et al. “Cataract Surgery and the 5-Year Incidence of Late-Stage Age-Related Maculopathy: Pooled Findings from the Beaver Dam and Blue Mountains Eye Studies.” Ophthalmology. 2003; 110:1960-1967.

2. Ferris, FL, Chew, EY, Gensler G, Milton R, and the Age-Related Eye Disease Study Research Group: Controversy of Cataract Extraction and AMD Progression.” Presentation, Retina 2005: Changing Concepts and Controversies, October 14, 2005, Chicago, Ill.