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S. Cugati, P. Mitchell, E. Rochtchina, A.G. Tan, W. Smith, J.J. Wang, Blue Mountains Eye Study; Cataract Surgery and the 10–Year Incidence of Age–Related Macular Degeneration: The Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1130.
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To assess whether prior cataract surgery is associated with an increased risk of 10–year incident age related macular degeneration (AMD).
The Blue Mountains Eye Study is a population–based cohort study of 3654 persons aged 49+ years at baseline, of whom 2335 participated in the 5–year and 1952 in the 10–year follow up examinations. At baseline, non–phakic (aphakic or pseudo–phakic) status was determined by an ophthalmologist via slit lamp examination and confirmed by lens photographic grading. Side–by–side grading of baseline and follow–up stereo retinal photographs was performed following the Wisconsin ARM grading system. Incident AMD was defined if either neovascular AMD or geographic atrophy developed in eyes without either lesion at baseline. Kaplan–Meier (product limit) estimates and generalised estimating equation models were used to analyse eye–specific data.
After excluding participants with either AMD lesion at baseline or those with missing photographs at either examination, 4763 eyes were considered at risk of incident AMD. Of these, 132 eyes had cataract surgery performed prior to baseline. AMD developed in 7.6% of non–phakic eyes compared to 2.1% of phakic eyes over 10 years. After adjusting for age, sex, smoking and baseline early AMD lesions (indistinct soft drusen and retinal pigmentary abnormalities), the relative risk (RR) for developing AMD in non–phakic eyes was 3.3 (95% confidence interval, CI, 1.1–9.9). The RR for incident neovascular AMD in nonphakic eyes was 3.4 (CI 1.1–10.9) and for geographic atrophy was 2.3(0.5–10.8).
Our findings from this older Australian population support an association between prior cataract surgery and an increased risk of developing AMD over the long–term, consistent with that previously reported from the Beaver Dam Eye Study on 10–year AMD risk and other population–based studies on 5–year AMD risk. The magnitude of the risk arising from cataract surgery is similar to the risk from current smoking. Our data suggest the need to study further the timing of cataract surgery in people with early ARM lesions.
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