Cataract Surgery and the Risk of Progression to Late Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2

Abstract

Purpose : Cataract surgery in patients with age-related macular degeneration (AMD) alleviates vision loss from cataracts, but controversy exists whether it contributes to AMD progression. This study evaluated the risk of late AMD progression following incident cataract surgery in a prospective cohort within a controlled clinical trial of oral supplementation for the treatment of AMD – the Age-Related Eye Disease Study 2 (AREDS2).

Methods : Participants 50 to 85 years with bilateral large drusen or unilateral AMD were enrolled in the AREDS2 study from 82 retinal specialty clinics in the US between 2006 – 2008 and followed until the conclusion of the clinical trial in 2012. After the end of the trial, an additional 5-year of follow-up was conducted via telephone every 6 months until 2018. Clinical information obtained by telephone was verified by collecting medical records of treating physicians. A subset of the AREDS2 participants was also evaluated in a final in-clinic study visit. The incidence of late AMD in eyes that received cataract surgery after the baseline visit and before any evidence of late AMD was compared with those that remained phakic until the study completion. Eyes that had at least 2 years of follow-up after cataract surgery were included in the analysis. We used Generalized Estimating Equations (GEE) and Cox regression models that were adjusted for age, sex, smoking, education, and AMD severity. Late AMD was defined as the presence of geographic atrophy (macular atrophy ≥430 mm) or neovascularization on annual stereoscopic fundus photographs or medical record documentation.

Results : A total of 1229 eyes (30%), of the 4064 participants in the AREDS2 study, had cataract surgery at a mean (SD) of 5.7 (3) years from study enrollment. The risk of late AMD after a mean (SD) of 4.6 (2.8) years from cataract surgery was not significant, Risk Ratio from GEE: 0.92 (95% Confidence Interval [CI]: 0.56-1.49,p=0.73). The Cox regression model showed that there was no increased risk for progression to late AMD after cataract surgery: hazard ratios 0.96 (95% CI, 0.8 –1.13,p=0.60) for the right eye and 1.05 (0.89–1.25,p=0.56) for the left eye.

Conclusions : Cataract surgery did not accelerate the rate of progression to late AMD among the AREDS2 participants with up to 10-year follow-up. This study provides data in counselling AMD patients who would benefit from cataract surgery.

This is a 2021 ARVO Annual Meeting abstract.