MyVisionTest News Archive
Nov 24, 2009
AREDS: Cataract surgery benefits persons with AMD
A new study finds that cataract surgery is likely to benefit pateints with all stages of age-related macular degeneration (AMD), from mild to advanced.
Cataract surgery is currently one of the most commonly performed surgeries in the United States. Cataract and age-related macular degeneration (AMD) often present concurrently in older persons. The presence of AMD has been highlighted as an important risk factor for poor visual outcome after cataract surgery. Given the expected increase in AMD prevalence during the next 2 decades, an analysis of the potential risks and benefits of cataract surgery in patients with AMD is of public health interest.
Methods and Results
This study involved a total of 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), a prospective, multicenter, epidemiological study of the clinical course of cataract and AMD and a randomized controlled trial of antioxidants and minerals.
Standardized lens and fundus photographs, performed at baseline and annual visits, were graded by a centralized reading center using standardized protocols for severity of AMD and lens opacities. History of cataract surgery was obtained every 6 months. Analyses were conducted using multivariate logistic regression.
The change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA was the main outcome measure.
Visual acuity results were analyzed for 1939 eyes that had cataract surgery during AREDS. The mean time from cataract surgery to measurement of postoperative BCVA was 6.9 months. After adjustment for age at surgery, gender, type, and severity of cataract, the mean change in visual acuity at the next study visit after the cataract surgery was as follows: Eyes without AMD gained 8.4 letters of acuity (P<0.0001), eyes with mild AMD gained 6.1 letters of visual acuity (P<0.0001), eyes with moderate AMD gained 3.9 letters (P<0.0001), and eyes with advanced AMD gained 1.9 letters (P = 0.04). The statistically significant gain in visual acuity after cataract surgery was maintained an average of 1.4 years after cataract surgery.
Discussion and Conclusions
This study describes the visual acuity outcomes from the largest cohort of persons with AMD undergoing cataract surgery that has been reported to date.
This study found a statistically significant gain of visual acuity in patients with AMD after cataract surgery. This gain in visual acuity was seen in all levels of AMD, including advanced cases with central geographic atrophy or neovascular changes. Furthermore, this statistically significant gain in visual acuity was maintained for at least 1 year after cataract surgery.
The findings of this study are particularly important in light of epidemiologic studies that suggest a harmful effect of cataract surgery on the acceleration of AMD progression. Findings from large epidemiological studies[29] and [30] of the increased risk of advanced AMD after cataract surgery have led some investigators to speculate that cataract surgery in patients with AMD is a “gamble” for both the patient and the surgeon. Data from AREDS suggest that there is little evidence of effect of cataract surgery on the risk of progression to advanced AMD.
The investigators conclude that, on average, participants with varying severity of AMD benefited from cataract surgery with an increase in visual acuity postoperatively. This average gain in visual acuity persisted for at least 18 months.
WHAT IT MEANS TO YOU: Recent studies of the effect that cataract surgery has on AMD confirms that cataract extraction does not accelerate the progression of macular degeneration. Now, this report from AREDS provides even more good news about cataract surgery in persons with AMD - that regardless of severity of AMD, a significant and lasting visual acuity benefit can be expected. This study removes any lingering doubts about the value of removing a mature cataract from patients with AMD.
Read more...
Ophthalmology. 2009 Nov;116(11):2093-100
A new study finds that cataract surgery is likely to benefit pateints with all stages of age-related macular degeneration (AMD), from mild to advanced.Cataract surgery is currently one of the most commonly performed surgeries in the United States. Cataract and age-related macular degeneration (AMD) often present concurrently in older persons. The presence of AMD has been highlighted as an important risk factor for poor visual outcome after cataract surgery. Given the expected increase in AMD prevalence during the next 2 decades, an analysis of the potential risks and benefits of cataract surgery in patients with AMD is of public health interest.
This study involved a total of 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), a prospective, multicenter, epidemiological study of the clinical course of cataract and AMD and a randomized controlled trial of antioxidants and minerals.
Standardized lens and fundus photographs, performed at baseline and annual visits, were graded by a centralized reading center using standardized protocols for severity of AMD and lens opacities. History of cataract surgery was obtained every 6 months. Analyses were conducted using multivariate logistic regression.
The change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA was the main outcome measure.
Visual acuity results were analyzed for 1939 eyes that had cataract surgery during AREDS. The mean time from cataract surgery to measurement of postoperative BCVA was 6.9 months. After adjustment for age at surgery, gender, type, and severity of cataract, the mean change in visual acuity at the next study visit after the cataract surgery was as follows: Eyes without AMD gained 8.4 letters of acuity (P<0.0001), eyes with mild AMD gained 6.1 letters of visual acuity (P<0.0001), eyes with moderate AMD gained 3.9 letters (P<0.0001), and eyes with advanced AMD gained 1.9 letters (P = 0.04). The statistically significant gain in visual acuity after cataract surgery was maintained an average of 1.4 years after cataract surgery.
Discussion and Conclusions
This study describes the visual acuity outcomes from the largest cohort of persons with AMD undergoing cataract surgery that has been reported to date.
This study found a statistically significant gain of visual acuity in patients with AMD after cataract surgery. This gain in visual acuity was seen in all levels of AMD, including advanced cases with central geographic atrophy or neovascular changes. Furthermore, this statistically significant gain in visual acuity was maintained for at least 1 year after cataract surgery.
The findings of this study are particularly important in light of epidemiologic studies that suggest a harmful effect of cataract surgery on the acceleration of AMD progression. Findings from large epidemiological studies[29] and [30] of the increased risk of advanced AMD after cataract surgery have led some investigators to speculate that cataract surgery in patients with AMD is a “gamble” for both the patient and the surgeon. Data from AREDS suggest that there is little evidence of effect of cataract surgery on the risk of progression to advanced AMD.
The investigators conclude that, on average, participants with varying severity of AMD benefited from cataract surgery with an increase in visual acuity postoperatively. This average gain in visual acuity persisted for at least 18 months.
WHAT IT MEANS TO YOU: Recent studies of the effect that cataract surgery has on AMD confirms that cataract extraction does not accelerate the progression of macular degeneration. Now, this report from AREDS provides even more good news about cataract surgery in persons with AMD - that regardless of severity of AMD, a significant and lasting visual acuity benefit can be expected. This study removes any lingering doubts about the value of removing a mature cataract from patients with AMD.
Read more...
Ophthalmology. 2009 Nov;116(11):2093-100
