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Michael Stock, David Vollman, Elizabeth Baze, Amy Chomsky, Mary K Daly, Mary Gilbert Lawrence; Functional visual improvement after cataract surgery in eyes with age-related macular degeneration; Results of the Ophthalmic Surgical Outcomes Data (OSOD) Project. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2798.
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To determine if cataract surgery on eyes with age-related macular degeneration (AMD) confer as much functional visual improvement as surgery on eyes without retinal pathology.
Retrospective analysis of 4,924 cataract surgery cases in the VA Ophthalmic Surgical Outcomes Data (OSOD) Project. Included cases of eyes with either AMD or no retinal pathology which had both preoperative and postoperative NEI-VFQ submitted. Excluded patients with history of other retinal pathologies including diabetic retinopathy, macular edema, or retinal detachment (740 patients). Analyzed and compared changes in visual acuity and overall functional visual improvement and its subscales using T-test, ANOVA, and linear regression modeling. Results were considered statistically significant for P-values less than 0.25 on 2-tailed analyses. The computations were completed using Excel’s statistical functions.
Of the 4,923 cataract cases in the OSOD database, 3871 (78%) had no retinal pathology and 312 (6.34%) had AMD. Preoperative and postoperative questionnaires were submitted by 58.3% of AMD and 63.8% of no retinal pathology cases. Analysis of overall score showed that cataract surgery on eyes with AMD led to an increase in visual function (13.8± 2.4, P<0.0001); however, increases were significantly less when compared to those in patients without retinal pathology (-6.4± 2.9, 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). AMD patients with vision of 20/40 or better had overall outcomes similar to controls (-2.2± 4.7, 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 preoperative visual acuity. For eyes with visual acuity ≥20/40, the improvement is similar to that seen in eyes without retinal pathology. However, if visual acuity is <20/40, the amount of improvement is significantly less than that seen in patients without retinal pathology.
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