No conclusions can be drawn linking cataract surgery, risk for AMD progression
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Key takeaways:
- Researchers found an insignificant difference in the relative risk of AMD progression after cataract surgery.
- A longer follow-up period was associated with faster progression of AMD.
Researchers could not draw conclusions about the effect of cataract surgery on the progression of age-related macular degeneration despite an existing association between the two, according to a study in Medicine.
“There is still a significant positive correlation between cataract surgery and increased risk of worsening of AMD progression, and faster progression of early-to-late AMD found in cataract surgery with longer follow-up of patients,” Zhaoyan Chen, PhD, from the department of pharmacy at West China Hospital of Sichuan University, and colleagues wrote. “However, based on the result of this review, we cannot draw conclusions about the effect of cataract surgery on the risk of worsening of AMD progression.”
In a systematic review and meta-analysis of eight cohort studies that compared visual acuity with or without cataract surgery in patients with AMD, Chen and colleagues evaluated the impact of cataract surgery on the progression of AMD.
Participants were aged 42 years or older, and the follow-up period ranged from 3 months to 20 years.
In their review, Chen and colleagues found an insignificant difference in the relative risk of AMD progression following cataract surgery (RR = 1.194; P = .225). However, the association between cataract surgery and AMD progression increased more than 5 years after surgery (RR = 1.372).
“More clinical trials (with sufficient statistical power) are needed, which should ideally be able to adequately control for confounding variables such as age and cataract severity, and subgroup analyses can be set up to make the study more precise,” researchers wrote.
Perspective
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Cecelia Koetting, OD, FAAO, DipABO
The intent of this study was to look for the possible effect of cataract surgery on progression of patients’ AMD, but it only evaluated visual acuity. As we know, visual acuity is only one factor that may or may not be affected in different stages depending on where the macular changes are occurring. To truly detect earlier structural changes that will precede measurable changes in visual acuity and contrast sensitivity, an OCT should be performed and reviewed.
Another downfall of this literature review analysis is that eight of the 12 studies included were 15 years or older. Clinical technology, treatment and understanding of AMD has changed significantly over the last 15 years. Older studies may not carry the same weight as those performed more recently with advanced retinal imaging. The same could be said for cataract surgery techniques and postoperative/intraoperative medications used.
This study highlights an interesting research hypothesis suggesting a positive relationship between cataract surgery and a 50% higher risk of AMD progression, from moderate to advanced phase within 5 years post-surgery. However, valid conclusions on the clinical values of the finding cannot be drawn given the limitations of this study. It has limited clinical information to contribute to current day clinicians’ understanding of AMD progression and cataract surgery. More research involving modern advanced diagnostic and treatment techniques is needed.
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Chen Z, et al. Medicine (Baltimore). 2022;doi:10.1097/MD.0000000000031566.
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