Does cataract surgery increase the risk of future development of late AMD? A nested case-control study from the AREDS2 and AREDS2 Follow-On studies

Abstract

Purpose : Previous studies have suggested that cataract surgery may increase the risk of developing late age-related macular degeneration (AMD). The Age-Related Eye Disease Study 2 (AREDS2) and AREDS2 Follow-On (A2FO) studies provided longitudinal information to assess the association between incident cataract surgery (CS) and risk of developing late AMD.

Methods : AREDS2 (2006-2012) was a randomized clinical trial evaluating the potential benefit of a modified nutritional supplement (lutein/zeaxanthin, zinc, and other nutrients) on the development of late AMD; A2FO (2013-2018) provided an additional 5 yrs of follow-up on a subset of AREDS2 participants. AREDS2 assessed CS status and AMD score at annual visits and, every 6-mos between visits, obtained information on CS and late AMD treatment (tx) by telephone. A2FO, initiated after the randomized trial concluded, assessed CS status and information on diagnosis and tx of late AMD at 6-monthly study visits via telephone only. Information regarding CS and tx for late AMD obtained by telephone was confirmed by medical record review. We identified case eyes (incident CS after AREDS2 randomization and no late AMD before or at the time of CS). The study visit when CS was first noted was used as the “baseline” visit for case eyes. We identified potential control eyes (no CS during AREDS2 or A2FO, no late AMD at AREDS2 randomization or before year 1). The year 1 study visit was used as the “baseline” visit for control eyes. We performed 1-1 propensity score matching (SAS 9.4) on age (at “baseline” visit), AMD score at the visit preceding the “baseline” visit, length of follow-up after the “baseline” visit, sex, education level, treatment group, smoking status, diabetes, aspirin use, and statin use. Matched pairs analysis and conditional logistic regression models were used to assess risk of developing late AMD (defined as photographic grading of late AMD or medical record documentation of diagnosis or tx of late AMD).

Results : There were 1201 case eyes and 2645 potential control eyes. Propensity score analysis identified 1081 matched pairs. 412 case eyes (CS) and 433 control eyes (no CS) developed late AMD after the “baseline” visit: matched pairs odds ratio, 0.92, 95% CI, 0.77-1.10, p=0.34.

Conclusions : In the AREDS2 and A2FO studies, cataract surgery did not appear to increase the risk of developing late AMD.

This is a 2021 ARVO Annual Meeting abstract.