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Emily Y Chew, Traci E Clemons, Elvira Agron, Daniel F Martin, Susan B Bressler, Gary Gensler, Henry Wiley, The Age-Related Eye Disease Study 2 Research Group; The Lack of Progression of Age-Related Macular Degeneration following Cataract Surgery in the Age-Related Eye Disease Study 2 (AREDS2). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2572. doi: https://doi.org/.
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The objective of this study was to evaluate the association of cataract surgery with progression of age-related macular degeneration (AMD) in AREDS2.
We limited our analyses to eyes without late AMD at baseline and excluded those that had developed late AMD (neovascular or central geographic atrophy) before cataract surgery. Eyes of eligible AREDS2 participants were matched based upon cataract surgery with the “case” group consisting of those who had cataract surgery while the “control” group never had cataract surgery. Matching criteria included: length of follow-up, AMD status at baseline, AREDS2 treatment assignment to lutein/zeaxanthin, age group at time of cataract surgery, severity of AMD status just before cataract surgery (for cases), and presence or absence of neovascular AMD in the fellow before cataract surgery.<br /> Clinical evaluations of lens status and fundus photographs with red reflex photos for lens status were obtained and graded centrally. History of cataract surgery or treatment for neovascular AMD was captured at annual visits and 6 month telephone calls that occurred between annual study visits. Analyses were conducted as the ratio (R) of case eyes (those with incident late AMD prior to matched control) to control eyes (those with incident late AMD prior to matched case). R>1 suggests increased likelihood of late AMD occurring sooner among cases (those having cataract surgery) than among the matched controls.
There were 1390 eyes with incident cataract surgery and following matching for the above variables, 989 cases (689 participants) remained in the analysis. Of these 989 case eyes, 912 (92%) were matched on almost all criteria. 483 (53%) matched pairs did not develop late AMD in either the case eye or the control eye. Far fewer eyes developed late AMD after cataract surgery than those who did not undergo surgery (R=105/322=0.33, 95% CI 0.11-0.55). For incident neovascular AMD, R was 0.39 (89/231) with 95% CI 0.14-0.63; and for incident central geographic AMD, R was 0.43 (52/120) with 95% CI 0.11-0.76.
We did not find a statistically significant association of progression to late AMD, either neovascular or central geographic atrophy with cataract extraction in the AREDS2 participants. Patients with intermediate AMD should consider cataract surgery when indicated.
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