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DF Martin, G Gensler, BE K Klein, R Klein, EY ChewAREDS Research Group; The Effect of Cataract Surgery on Progression to Advanced AMD . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1907.
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Purpose: To examine whether cataract surgery accelerates progression to advanced AMD. Methods: In the Age-Related Eye Disease Study (AREDS), there were 2,556 participants who at baseline had at least intermediate AMD in one eye and some measurable follow-up. Participants were randomly assigned to receive daily tablets containing antioxidants (vitamins C and E and beta carotene); zinc (with copper); antioxidants plus zinc; or placebo. The primary outcome measure for this analysis was progression to advanced AMD as measured by a photographic reading center or the verification of photocoagulation at a study visit. Participants were grouped into one of three baseline AMD categories: 1) advanced AMD or vision loss due to AMD in one eye only, 2) large drusen OU, 3) large drusen in one eye or extensive intermediate drusen in at least one eye. A single eye was selected from each participant for analysis. The one available study eye was selected when the fellow eye had advanced AMD, vision loss due to AMD, or a disqualifying lesion. For participants with two study eyes, the eye with more severe AMD was selected; a random eye was selected if the AMD severity was the same in both eyes. A Cox proportional hazards model was used to evaluate progression to advanced AMD with cataract surgery as a time-dependent covariate. Results: Median follow up was 6.15 years. Median age at baseline was 70 years and 55% were female. 60% percent of eyes had neither progression to advanced AMD nor cataract surgery, 14% had cataract surgery only, 21% progressed to advanced AMD only, and 5% of eyes (130) had both events. Among the 130 eyes with both events, nearly 75% had cataract surgery prior to progression to advanced AMD. An analysis adjusted for age, treatment assignment, and baseline AMD category showed that cataract surgery as a time-dependent covariate did not significantly accelerate progression to advanced AMD (RR=1.06, 95% CI: 0.85-1.32). Analysis of the 625 participants assigned to placebo showed a non-significant association between cataract surgery and progression to advanced AMD (RR=1.34, 95% CI: 0.90-1.97). Conclusion: Cataract surgery does not appear to significantly accelerate progression to advanced AMD among persons at moderate risk for progression.
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