Visual Acuity Outcomes and Disease Progression in Intermediate Stage Non-exudative Age-Related Macular Degeneration Following Cataract Surgery

Abstract

Purpose : Cataract surgery has been shown to produce variable visual acuity (VA) improvement in those with age-related macular degeneration (AMD) and prognostic factors are incompletely understood. The purpose of this study was to evaluate VA outcomes following cataract surgery in intermediate stage non-exudative AMD (iAMD) patients, and to determine prognostic factors for post-operative VA and risk of conversion to exudative AMD (nAMD).

Methods : Retrospective study of patients with iAMD and control eyes without maculopathy who had cataract surgery in 2015-2017 at the Cleveland Clinic. Pre-operative data included VA, optical coherence tomography (OCT) data, duration of AMD, and demographic factors. Outcome measures were VA and conversion to nAMD at post-operative month 1 (POM1) and post-operative month 12 (POM12). Prognostic factors for POM12 change in VA were assessed by multivariate analysis. Relationships between baseline factors and progression to nAMD were analyzed by Kruskal-Wallis Test and Fisher Exact Test.

Results : 216 eyes with iAMD and 130 control eyes were included. At POM12, iAMD patients showed significant gain in VA (p<0.01), though lower than that of controls (+10.1±14.5 vs +17.1±9.7 letters, respectively, p<0.01). POM12 VA was also lower (73.7±13.1 vs 79.5±6.8 letters, respectively, p<0.01). When stratified by pre-operative VA, iAMD patients with VA≥20/40 had similar POM12 VA to controls (p=0.20 for 20/40, p=0.50 for >20/40). In multivariate analysis, shorter AMD duration and worse pre-operative VA were associated with greater VA gain at POM12 (p<0.05). Eight (4%) of 216 eyes converted to nAMD by POM12. Longer AMD duration was significantly associated with conversion (p<0.001), while gender, age, tobacco use, baseline VA, and OCT variables were not significantly associated.

Conclusions : Cataract surgery significantly improves VA in iAMD. VA improvement is generally less than that of patients without macular disease, but may be similar for those with good pre-operative VA. Longer duration of AMD is associated with worse visual outcomes and greater risk of progression to nAMD.

This is a 2020 ARVO Annual Meeting abstract.

 

Figure 1. VA in iAMD vs controls. (A) At baseline, POM1, and POM12. (B) At POM12, stratified by baseline VA. Dots, means; error bars, standard deviation. *p<.05, iAMD vs control. ⁺p<0.05 vs baseline.