It is no secret that macular degeneration and cataracts are two of the most common eye conditions found in the aging population. But what you might not know is that there seems to be an increasing number of patients with coexisting cataracts and AMD. And naturally, when both conditions are present at once, it can pose distinctive challenges to the retinal specialist, cataract surgeon and the patient himself.
Unsurprisingly, a patient with these circumstances will often turn to the diagnosing ophthalmologist with a bevy of questions. Such inquiries might include some of the following: will cataract surgery improve my vision? Will cataract surgery worsen my macular degeneration? Is it the cataracts or the AMD that is primarily causing my vision loss? What sort of precautions can we take? And how can we improve my overall vision by treating one condition? Such questions can be difficult to answer and are best analyzed on a patient to patient basis.
Additionally, for many years there have been questions regarding whether cataract surgery can, in fact, contribute to the severity and progression of age-related macular degeneration in patients who have both conditions. It has been theorized that the removal of the crystalline lens that takes place during cataract surgery may accelerate AMD by allowing more blue light to enter the eye. 1 Moreover, it was thought that the post cataract surgery inflammatory response (even when not unusual) could be particularly dangerous for already at risk eyes. The aforementioned would prove to be a contraindication for AMD/cataract patients looking to undergo cataract surgery; but it must be also mentioned that these notions have never actually been formally proven.
Indeed, a study by Shuttleworth et al. 1 that was conducted to assess the benefits of cataract extraction in patients with dry AMD proved the opposite. In fact, the researchers discovered that the majority of subjects reported a benefit in visual acuity and quality of life post cataract surgery. Not only this, but the study found that the development of advanced AMD did not worsen significantly in the subjects. It seems that with preoperative treatment and non-steroidal anti-inflammatory drugs, doctors are able to effectively stabilize the blood-retina barrier and reduce blood vessel leakage in AMD patients following cataract surgery. 2
Thus, when it comes to patients with visually hindering cataracts, AMD should not necessarily be considered a contraindication for surgery. There are no definitive answers for preserving and optimizing vision in patients with both of these conditions and each individual patient must be evaluated thoroughly prior to having the procedure. However, once proper precautions and preoperative measures are taken, cataract removal may actually result in a significant improvement in an AMD patient’s vision.