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Michael V. Stock, David E. Vollman, Elizabeth F. Baze, Amy S. Chomsky, Mary K. Daly, Mary G. Lawrence; Functional Visual Improvement After Cataract Surgery in Eyes With Age-Related Macular Degeneration: Results of the Ophthalmic Surgical Outcomes Data Project. Invest. Ophthalmol. Vis. Sci. 2015;56(4):2536-2540. doi: 10.1167/iovs.14-16069.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if cataract surgery on eyes with AMD confers as much functional visual improvement as surgery on eyes without retinal pathology.
This is a retrospective analysis of 4924 cataract surgeries from the Veterans Healthcare Administration Ophthalmic Surgical Outcomes Data Project (OSOD). We included cases of eyes with AMD that had both preoperative and postoperative NEI-VFQ-25 questionnaires submitted and compared their outcomes with controls without retinal pathology. We excluded patients with other retinal pathologies (740 patients). The analyses compared changes in visual acuity and overall functional visual improvement and its subscales using t-tests, multivariate logistic regressions, and linear regression modeling.
Preoperative and postoperative questionnaires were submitted by 58.3% of AMD and 63.8% of no retinal pathology cases (controls). Analysis of overall score showed that cataract surgery on eyes with AMD led to increased visual function (13.8 ± 2.4 NEI-VFQ units, P < 0.0001); however, increases were significantly less when compared with controls (−6.4 ± 2.9 NEI-VFQ units, P < 0.0001). Preoperative best-corrected visual acuity (preBCVA) in AMD was predictive of postoperative visual function (r = −0.38, P < 0.0001). In controls, postoperative visual function was only weakly associated with preBCVA (r = −0.075, P = 0.0002). Patients with AMD with vision of 20/40 or better had overall outcomes similar to controls (−2.2 ± 4.7 NEI-VFQ units, P = 0.37).
Cataract surgery on eyes with AMD offers an increase in functional visual improvement; however, the amount of benefit is associated with the eye's preBCVA. For eyes with preBCVA of 20/40 or greater, the improvement is similar to that of patients without retinal pathology. However, if preBCVA is less than 20/40, the amount of improvement was shown to be significantly less and decreased with decreasing preBCVA.
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