Visual Acuity Outcomes after Cataract Surgery in Patients with Age-Related Macular Degeneration: Age-Related Eye Disease Study Report No. 27

Abstract

Objective-To evaluate visual acuity outcomes after cataract surgery in patients with varying degrees of age-related macular degeneration (AMD). Design-Cohort study.Participants-A total of 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), a prospective, multicenter, epidemiological study of the clinical course of cataract and AMD and a randomized controlled trial of antioxidants and minerals.Methods-Standardized lens and fundus photographs, performed at baseline and annual visits, were graded by a centralized reading center using standardized protocols for severity of AMD and lens opacities. History of cataract surgery was obtained every 6 months. Analyses were conducted using multivariate logistic regression.Main Outcome Measure-The change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA.Results-Visual acuity results were analyzed for 1939 eyes that had cataract surgery during AREDS. The mean time from cataract surgery to measurement of postoperative BCVA was 6.9 months. After adjustment for age at surgery, gender, type, and severity of cataract, the mean change in visual acuity at the next study visit after the cataract surgery was as follows: Eyes without AMD gained 8.4 letters of acuity (P<0.0001), eyes with mild AMD gained 6.1 letters of visual acuity (P<0.0001), eyes with moderate AMD gained 3.9 letters (P<0.0001), and eyes with advanced AMD gained 1.9 letters (P = 0.04). The statistically significant gain in visual acuity after cataract surgery was maintained an average of 1.4 years after cataract surgery. population have led to a steady increase in cataract surgery rates in the United States during the past 2 decades. 2-4 Both initial and fellow-eye cataract surgery have been demonstrated to be highly cost-effective compared with procedures across multiple medical specialties. 5,6 The benefit of cataract surgery in the general population with respect to visual acuity and visual function has been established. 7,8 Cataract and age-related macular degeneration (AMD) often present concurrently in older persons. [9][10][11] The presence of AMD has been highlighted as an important risk factor for poor visual outcome after cataract surgery. [12][13][14] Given the expected increase in AMD prevalence during the next 2 decades, 15 an analysis of the potential risks and benefits of cataract surgery in patients with AMD is of public health interest. Conclusions-OnSeveral studies have examined the potential benefit of cataract surgery with respect to visual acuity and visual function in patients with AMD. [16][17][18][19][20][21][22] However, prior studies have been limited by the lack of a standardized grading system for AMD and cataract, inclusion of patients with other ocular comorbidities, small sample sizes, and lack of manifest refracted visual acuities before and after cataract surgery. [16][17][18][19]21 Furthermore, in previous studies persons with advanced AMD were underrepresented in the cohort 16,20,21 or not included. 19,22The Age...

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“…More recently, studies published have not showed an increase in recurrence, number of injections or worsening of visual acuity when compared with non-operated eyes [15,16,[25][26][27][39][40][41][42][43][50][51][52][53][54][55][56]. However, Lee and cols.…”

“…The studies published about cataract surgery in patients with neovascular AMD are mainly retrospective, FAG was only performed as a diagnostic test and not on the follow-up; some of them without control group and with short periods of follow-up [15,16,[25][26][27][39][40][41][42][43][50][51][52][53][54][55]58]. In addition, the protocols used in the reported studies, were inhomogeneous (treat and extend, pro-re-nata and monthly injections), but none compared these protocols between them, or even between different anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) [38,39,[41][42][43][52][53][54][55].…”

“…In addition, the protocols used in the reported studies, were inhomogeneous (treat and extend, pro-re-nata and monthly injections), but none compared these protocols between them, or even between different anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) [38,39,[41][42][43][52][53][54][55]. Then, it is required prospective research of causality and not only epidemiological studies, with long periods of follow-up to clarify studies published until now concerning this issue.…”

Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension?

“…[1][2][3] It has been suggested that the 1-day postoperative intraocular pressure (IOP) check post routine uncomplicated phacoemulsification can be abandoned for a number of reasons. 1,[4][5][6][7] Some of these include the fact that new surgical complications are unlikely to be picked up on the first day, peak IOP may have already passed, economical constraints, improved postoperative outcomes and low complication rates.…”

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

“…Large studies have shown that cataract surgery in these patients can provide sustained improvements in visual acuity. 14,15 However, the impact of the procedure on the course of retinal disease remains controversial. 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.…”