Considerations: Cataracts, Cataract Surgery & Age Related Macular Degeneration (ARMD)

Reviewed by:

Leslie Doctor, MD

A Cataract is a clouding of the normally transparent Crystalline Lens of the eye. Depending on the severity of the clouding, sometimes Cataracts cause only a limited disturbance in vision and other times they can result in noticeable symptoms including blurriness, light sensitivity, glare, and distortion as well as fading of colors. Cataracts are very common as we get older. In fact in the United States it is generally reported that Cataracts affect about 40% of those between the ages of 50-65, 50% of those between the ages of 65-75 and about 90% of those 75-85 years of age.

Unfortunately, as the incidence of Cataract increases with age, so does the incidence of Age Related Macular Degeneration (ARMD). Age Related Macular Degeneration (ARMD) is a degenerative condition of the Retina in which the central portion of the Retina, called the Macula, is damaged as a result of the hardening of the small arteries supplying oxygen and nutrients to the Retinal tissue. This can cause a significant compromise in your central vision. Central or “straight ahead” vision is necessary for reading and driving. The older you are, the greater the chance that Macular Degeneration will affect you.

Two questions that should be considered as you become “of age” for Cataracts and Age Related Macular Degeneration (ARMD) are:

  • Should I have Cataract Surgery if I have a Cataract along with ARMD?
  • Does Cataract Surgery increase the risk that I will develop a more progressive type of ARMD?

Researchers reported the results of a study titled “Is Cataract Surgery Justified in Patients with Age Related Macular Degeneration? A Visual Function and Quality of Life Assessment” in the British Journal of Ophthalmology (December 2000) in which they concluded, “ There were significant improvements both in terms of quality of life and visual function measures in the study group. Benefits were greater in patients with moderate cataract irrespective of the degree of ARMD. Patients with mild and moderate degrees of ARMD do benefit from cataract surgery and the benefits are greater in patients with moderate degrees of lens opacity.”

The general recommendation of Cataract Surgeons is that with proper preoperative diagnostic testing, examination and consultation, patients who have Age Related Macular Degeneration (ARMD) and who develop a Cataract are able to have Cataract Surgery after being counseled on what to expect from Cataract Surgery with regard to vision and lifestyle benefit. While ARMD is not a reason to avoid Cataract Surgery, realistic expectations must be established by and between the Cataract Surgeon and the patient.

There has been considerable research, discussion and publication regarding whether Cataract Surgery increases the risk of developing ARMD or possibly causes the progression of ARMD.

In the Beaver Dam and Blue Mountain Eye Studies (Ophthalmology: October 2003) the authors concluded, “cataract surgery in older persons may, in fact, be associated with an increased incidence of late staged age related maculopathy”.

This was followed by a more comprehensive study presented at the 2005 American Academy of Ophthalmology meeting titled Controversy of Cataract Extraction and AMD Progression: Changing Concepts and Controversies in which the authors (Ferris, FL, Chew, EY, Gensler, G, Milton R and the Age Related Eye Disease Study Research Group) showed that those patients who had Cataract Surgery did not have a higher risk of progressing to more advanced forms of Macular Degeneration, when compared to those who did not have Cataract Surgery.

Last, the most recent discourse on Cataract Surgery and AMD progression was reported by Emily Chew, M.D. and colleagues in the publication Risk of Advanced Age Related Macular Degeneration After Cataract Surgery in the Age Related Eye Disease Study. AREDS Report 25 (Ophthalmology: November 2009) after considering 11 years of patient follow-up from the large scale Age Related Macular Degeneration Study (AREDS). Chew and her team concluded, "The frequency of neovascular age-related macular degeneration, geographic atrophy, and central geographic atrophy did not differ between patients who had cataract surgery and those who did not. . . [This] may provide some reassurance to patients with age-related macular degeneration who are considering cataract surgery."

Most eye surgeons agree that the early studies had inherent population biases and that the techniques of Cataract Surgery and types of Intraocular Lens Implants (IOL)s used today offer greater protection of the Macula and decrease the risk of AMD progression.

The information that has been provided here is intended to give patients a basic understanding of Cataract Surgery and Age Related Macular Degeneration (ARMD). It is possible that your individual experience might be different. None of the information provided here is meant to be a substitute for or replace your eye doctor's consultation nor does it replace the need for you to consult with a Cataract Surgeon about specific details of Cataract Surgery and Intraocular Lens (IOL) Implantation.

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