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Beware macular disease in cataract patients, retina surgeon says
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KOLOA, Hawaii — Diminished visual acuity due to pre-existing macular disease is the most common reason for patient dissatisfaction after cataract surgery, according to a retinal surgeon speaking here.
“I thought hard about this before I said it is ‘the most common complaint’,” said Carmen A. Puliafito, MD, MBA, speaking at a session on cataract surgery and IOLs at Hawaii 2004: the Royal Hawaiian Eye Meeting. Dr. Puliafito is one of the program directors of the meeting.
“Make sure the macula is normal — and I do mean normal — before you operate,” he said.
Dr. Puliafito advised cataract surgeons to obtain an optical coherence tomography (OCT) study for all patients with suspected retinal pathology. The OCT can identify the presence of preretinal membranes and other macular pathology that might affect the outcome of cataract surgery, he said.
Patients with existing macular problems may benefit from cataract surgery in some cases, he said, but it may be helpful to lower the visual expectations of these patients.
“We are at the forward edge of a macular degeneration epidemic,” Dr. Puliafito said, as the baby boomer generation moves into old age. He said AMD is due in part to genetic disposition, but physicians must consider what they and their patients can do to modify the risks of developing the condition. Currently, vitamin supplementation and reduction of blue light transmission to the retina are the only such options, he said. He advised cataract surgeons to consider implanting blue-light blocking IOLs, such as the Alcon AcrySof Natural, in patients who might be predisposed to AMD.
Dr. Puliafito acknowledged a financial interest in the OCT technology, which he helped to develop.