Cataract surgery may improve visual acuity in patients with AMD
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Cataract surgery improved visual acuity for patients with intermediate age-related macular degeneration and neovascular AMD, according to a study published in the Canadian Journal of Ophthalmology.
“In summary, we found that patients with [geographic atrophy] do not experience significant visual acuity gain with cataract surgery, whereas those with iAMD [intermediate AMD] and nAMD [neovascular AMD] do,” Andrew X. Chen, BSE, of Case Western Reserve University School of Medicine and the Center for Ophthalmic Bioinformatics in Cleveland, and colleagues wrote. “Control groups each exhibited significantly higher postoperative VA [visual acuity] and larger improvements in VA compared with their respective AMD groups. In all AMD groups, preoperative VA was a strong predictor of visual outcomes, and individuals with the worst preoperative vision gained the most letters.”
Chen and colleagues designed a retrospective cohort study to evaluate postoperative VA outcomes in AMD patients who underwent cataract surgery. They compared AMD patients with healthy control participants, all of whom underwent cataract surgery between 2012 and 2017.
The researchers categorized the eyes into three AMD groups: iAMD (216 patients), fovea-involving geographic atrophy (GA; 35 patients) and nAMD (184 patients). These groups were compared with three preoperative VA-matched control groups: iAMDc (130 ), fovea-involving GA control (GAc; 31) and neovascular AMD control (nAMDc; 129). The researchers used multiple linear regression models to evaluate changes in VA at 12 months.
According to the study, 12-month postoperative VA increased significantly in the iAMD (+10.1 ± 14.5 letters) and nAMD (+9.7 ± 18.9 letters) groups. In addition, each control group showed significant VA gains (iAMDc: +17.1 ± 9.7; GAc: +30 ± 12.9; and nAMDc: +26.4 ± 15.6 letters, P < .001 for all). For AMD groups, VA and gain in VA were lower than in the control groups 12 months postoperatively (P < .01), with better preoperative VA predicting smaller VA gains (P .007), while poorer VA outcomes were linked with longer duration of AMD in patients with iAMD, ellipsoid zone disruption in nAMD and lower central subfield thickness in GA (P < .05).
These findings support previous research on VA improvements from cataract surgery in patients with iAMD and nAMD and also suggest that cataract surgery can modify aspects of visual function such as glare, contrast sensitivity, color vision and peripheral vision in fovea-involving GA.
“Cataract surgery improves VA for patients with iAMD and nAMD, albeit not to the level of those without retinal pathology,” Chen and colleagues wrote. “Preoperative VA, AMD duration and OCT parameters may be important prognostic factors for cataract surgery in patients with AMD.”
Perspective
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“Will cataract surgery improve my vision?” is a question all optometrists hear. The answer can be difficult to answer for patients with concomitant retinal disease, such as AMD. While a definitive answer may not be possible, this study offers some guidance to help manage patient expectations.
This study confirms what previous research has found, which is that patients with either intermediate AMD or neovascular AMD show greater improvement in visual acuity than those with geographic atrophy.
What stood out to me in this article was the question regarding whether cataract surgery exacerbates AMD. Patients with AMD may be hesitant to undergo cataract surgery if they fear their vision will worsen. This study specifically examined fovea-involved geographic atrophy and was able to show that while improvements in acuity were guarded, no atrophic expansion was noted. This was also the outcome for patients with nAMD, who did not require an increase in anti-VEGF injections postoperatively.
As we discuss the likelihood of improved visual acuity following cataract surgery with our patients it is important to note what this study mentioned. Not all improvements in visual function come from acuity alone. Cataract surgery may improve visual function through aspects like glare, contrast and color vision.
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