May 2019

CATARACT

Presentation spotlight
Do cataracts accelerate wet AMD?
New study takes a look at risk factors


by Stefanie Petrou Binder, MD EyeWorld Contributing Writer

Is cataract surgery compatible in eyes with wet AMD or should it be put off? Data from a large, register-based, data cohort study from the Swedish National Cataract and Macula Registries identified factors associated with worsening of wet AMD and offered ways in which surgeons can help to protect eyes after surgery.
“The investigation was carried out in order to characterize pre- and perioperative risk factors and protective factors for the treatment of wet age-related macular degeneration treatment after cataract surgery,” said Anders Behndig, MD, who spoke on the topic at the 36th Congress of the European Society of Cataract and Refractive Surgeons. “We identified a few expected risk factors for undergoing treatment for wet AMD after cataract surgery including female gender, high age, and low visual acuity. In eyes that showed evidence of AMD already before cataract surgery, the use of a blue blocking IOL appeared to have a slightly protective effect from progression to wet AMD requiring treatment.”
For all first eye cataract surgeries registered in the Swedish National Cataract Registry between 2010 and 2017, matching eyes were located in the Swedish Macula Registry that had undergone treatment for wet AMD either 1 year or longer after the cataract procedure. Eyes with and without preoperative (dry) AMD were analyzed separately, and eyes not treated for AMD within the same time period were used as controls.
Pre- and perioperative risk factors were identified along with protective factors for undergoing wet AMD treatment after routine cataract surgery, with special attention to the use of blue blocking IOLs.
Of the 120,903 first eye surgeries with preoperative AMD and 452,238 first eye surgeries without preoperative AMD that were performed between Jan. 1, 2010 and Sept. 1, 2017, 744 eyes (0.6%) with AMD and 954 eyes (0.2%) without AMD underwent treatment for wet AMD at least 1 year after the cataract procedure.
The investigation revealed that female gender was a general risk factor for AMD progression (P≤.002), as were older age (P<.001) and low visual acuity (P=.006), which were associated with an increased risk but only in eyes without AMD before the cataract procedure.
The study data showed that the use of a blue blocking IOL did not influence the risk for undergoing subsequent treatment for wet AMD in eyes without preoperative AMD but appeared to have a slight protective effect in eyes with preoperative AMD (P=.021).
Dr. Behndig’s investigation sheds some light on a conflicting issue. Cataract surgery has been implicated in the past for inducing AMD in older patients. One study that assessed the association between cataract surgery (5,913 patients) and the rate of photodynamic therapy (PDT) for AMD (283 patients) within the chronic disease registry of Israel’s largest HMO between 2001 and 2005 identified an increased rate of PDT 1 to 1.5 years after cataract surgery.1
Another study suggests that evidence pointing toward the development of neovascular AMD following cataract surgery is largely anecdotal and lacking clinical trials. In the study, the researchers searched several large databases in 2012 for randomized controlled trials that compared cataract surgery to no surgery in eyes with AMD. One randomized controlled trial was identified that showed no significant difference between the two groups.2
Patients with cataract and wet AMD underwent safe cataract surgery, according to a different study in which 81 eyes had cataract surgery and received at least one anti-VEGF injection between 2012 and 2016. This study found the procedures compatible, with no worsening of neovascularization after surgery.3 Patients
with visually significant cataract and AMD demonstrated improved visual acuity, absence of significant disease progression, and improved quality of life, according to yet another investigation.4

About the doctor

Anders Behndig, MD
Department of Clinical Sciences/Ophthalmology
Umea University Hospital
Umea, Sweden

References

1. Kaiserman I, et al. Cataract surgery is associated with a higher rate of photodynamic therapy for age-related macular degeneration. Ophthalmology. 2007;114:278–82.
2. Casparis H, et al. Surgery for cataracts in people with age-related macular degeneration. Cochrane Database Syst Rev. 2012;CD006757.
3. Starr MR, et al. Outcomes of cataract surgery in patients with exudative age-related macular degeneration and macular fluid. Am J Ophthalmol. 2018;192:91–97.
4. Ehmann DS, Ho AC. Cataract surgery and age-related macular degeneration. Curr Opin Ophthalmol. 2017;28:58–62.

Financial interests

Behndig: None

Contact information

Behndig
: anders.behndig@ophthal.umu.se
Do cataracts accelerate wet AMD? New study takes a look at risk factors Do cataracts accelerate wet AMD? New study takes a look at risk factors
Ophthalmology News - EyeWorld Magazine
283 110
283 110
,
2019-05-06T14:22:52Z
True, 5