Visual outcomes following cataract surgery in geographic atrophy patients in routine clinical practice

Abstract

Purpose : Few studies have assessed visual outcomes, including prognostic variables, of cataract surgery in patients with geographic atrophy (GA) in the setting of age-related macular degeneration. This study aims to determine visual acuity (VA) outcomes of cataract surgery in patients with fovea-involving GA and to assess the prognostic value of baseline ocular and systemic characteristics.

Methods : This retrospective cohort study compared patients with fovea-involving GA to age- and baseline VA-matched control patients undergoing cataract surgery from 2015-2017 at the Cleveland Clinic. VA and optical coherence tomography (OCT) data including central subfield thickness (CST) and retinal pigment epithelium (RPE) sub-illumination area within 5 mm of foveal center were collected at pre-operative, post-operative month 1 (POM1), and post-operative month 12 (POM12) visits. POM12 VA was the primary outcome measure.

Results : Thirty-five eyes with fovea-involving GA and 31 controls were included. GA and control groups were similar in terms of baseline VA (37.3±19.5 and 45.1±12.6 ETDRS letters, respectively, p=0.06), age (79.3±6.8 and 77.6±4.1 years, respectively, p=0.11), and proportion of smokers or former smokers (77.1% and 58.1%, respectively, p=0.10). At POM12, the GA cohort had no significant change in VA from baseline (+2.1 ± 17.3 letters, p=0.68), while the control cohort experienced a significant gain in VA (+30.0±12.9 letters, p<0.01). GA area, as represented by RPE sub-illumination area based upon SDOCT, did not change between baseline and 12 months when adjusting for baseline size (5.7 vs. 6.1 mm², p=0.78). Baseline VA (p=0.007) and CST (p=0.015) were significant predictors of change in VA at POM12, and were negatively and positively associated, respectively. Age at surgery and GA area at baseline were not significant predictors.

Conclusions : Cataract surgery may provide marginal benefit to VA in fovea-involving GA, but may still offer visual benefits not measured by VA and should be considered on a case-by-case basis.

This is a 2020 ARVO Annual Meeting abstract.