The Relationship of Cataract and Cataract Extraction to Age-related Macular Degeneration: The Beaver Dam Eye Study

Abstract

Objective To examine the associations of cataract and cataract surgery with early and late age-related macular degeneration (AMD) over a 20-year interval. Design Longitudinal population-based study of age-related eye diseases. Participants: Beaver Dam Eye Study participants. Methods All persons 43-84 years of age were recruited in 1987-1988. Participants were followed up at five year intervals after the baseline examination in 1988-1990. Examinations consisted of ocular examination with lens and fundus photography, medical history, measurements of blood pressure, height, and weight. Values of risk variables were updated, and incidences of early and late AMD were calculated for each 5-year interval. Odds ratios were computed using discrete linear logistic regression modeling with generalized estimating equation methods to account for correlation between the eyes and multiple intervals. Main Outcome Measures AMD. Results After controlling for age and sex, neither cataract nor cataract surgery was associated with increased odds for developing early AMD. Further controlling for high risk gene alleles (CFH and ARMS2) and other possible risk factors did not materially affect the odds ratio (OR). However, cataract surgery was associated with incidence of late AMD (OR 1.93; 95% CI 1.28, 2.90). This OR was not materially altered by further controlling for high risk alleles (CFH Y402H, ARMS2) or for other risk factors. The OR for late AMD was higher for cataract surgery performed 5 or more years prior as compared to less than 5 years prior. Conclusions These data strongly support the past findings of an association of cataract surgery with late AMD independent of other risk factors including high risk genetic status, and suggest the importance of considering these findings when counseling patients regarding cataract surgery. These findings should provide further impetus for the search for measures to prevent or delay the development of age-related cataract.

Estrogen Signalling in the Pathogenesis of Age-Related Macular Degeneration

“…22 Furthermore, Klein et al observed a clear association between cataract surgery and late AMD independently of other risk factors, including a highrisk genetic status. 41 They emphasize the importance of considering these findings when counseling patients on a cataract surgery. Their data is in line with a recent meta-analysis that considers previous cataract surgery as a consistent risk factor for AMD.…”

The Impact of Cataract Surgery on AMD Development and Progression

“…The authors have continued to update their findings at five-year intervals and these statistical findings are detailed in Table 1. 8,32 In the Australian Blue Mountains Eye Study of 2454 participants, although initial cross-sectional analysis indicated no association between cataract and AMD, 33 the investigators noted a three-fold increase at 10 years of developing late AMD in those with a history of previous cataract surgery (Odds ratio (OR) 3.3 [95% confidence interval (CI) 1.1-9.9]). 7 In particular, this effect was most pronounced for nAMD ( …”

“…[1][2][3][4] Meanwhile, cataract progression is the most widespread cause of blindness worldwide, affecting nearly 20 million people. 1,2,[5][6][7][8][9][10][11][12][13][14] Cataract surgery remains the only treatment available to definitively remove lens opacification once visual decline has occurred.…”

The Role of Ultra-widefield Retinal Imaging as a Standard Assessment Tool in the Cataract Practice

“…Some evidence suggests increases in both the incidence and progression rate of diabetic retinopathy at 1 year after phacoemulsification cataract surgery, and findings are inconsistent from large studies about the association between cataract surgery and long-term risk for the development of either early or late AMD. [16][17][18] It is clearer that the risk of post-surgical cystoid macular edema is increased in patients with a history of retinal vein occlusion or epiretinal membrane. 19 Given the totality of the available evidence and our own experience, we are very conservative in the presence of retinal findings and maintain a low threshold for referral to a retinal specialist for further evaluation, including a dilated fundus exam and OCT, and potential treatment (see Figures 3 and 4).…”