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  • AMD Progression Unaffected by Cataract Surgery

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD, and reviewed by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, April 2022

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    Although cataract surgery improves vision in patients with age-related macular degeneration (AMD), pre­vious large studies have differed as to whether cataract surgery accelerates AMD progression. In the Beaver Dam Eye Study, two decades of follow-up in­dicated a link between cataract surgery and late AMD, but this was not true of the Age-Related Eye Disease Study 2 cohort (AREDS2). Bhandari et al. further explored this question in a prospective AREDS2 cohort of patients who eventually had bilateral large drusen or unilateral late AMD. In their study, eyes that had cataract sur­gery before evidence of late AMD were compared with eyes that remained phakic (controls). During follow-up of two to 10 years, the authors found no correlation between cataract surgery and elevated risk of late AMD.

    Eligible for cohort inclusion were AREDS2 participants aged 50 to 85 years who received oral supplementa­tion or placebo in AREDS2 and had at least two years of follow-up after cataract surgery.

    The main outcome was develop­ment of late AMD, determined primar­ily by fundus photography. Late AMD was defined as any of the following: two or more common signs of neovas­cularization, a history of treatment for neovascular AMD, or an area of geo­graphic atrophy ≥433 μm in diameter. Cox regression analysis, matched-pair analysis, and logistic regression models were adjusted for age, sex, smoking status, education, treatment group, and AMD severity.

    Of the 8,406 eyes in AREDS2, those with a history of cataract surgery (n = 2,370) or late AMD (n = 970) at base­line were not entered into the cohort study. After eyes with insufficient follow-up for AMD were excluded, 4,553 eyes remained for Cox propor­tional hazard analysis. Altogether, 1,767 eligible eyes underwent cataract surgery. Late AMD occurred in 1,981 eyes during the mean follow-up period of nine years. Cox regression analysis did not show a higher risk of late AMD after cataract surgery for right eyes (hazard ratio, .96; p = .60) or left eyes (hazard ratio, 1.05; p = .56). Among matched pairs, late AMD was detected in 408 eyes that had cataract surgery and in 429 phakic control eyes (odds ratio, .92; p = .34). In the logistic regres­sion model, the risk of late AMD after cataract surgery was not significant (risk ratio, .92; p = .73).

    Major differences between popula­tion-based studies and AREDS2 include available techniques and IOLs, said the authors, who cautioned that their find­ings may not be generalizable because AREDS2 participants were healthy volunteers. Even so, the data may be helpful when counseling patients with AMD who are considering cataract surgery.

    The original article can be found here.