New Data on the Reported Link
between Cataract Surgey and AMD
Paul Mitchell
MD PhD FRANZCO
University of Sydney Department of Ophthalmology
Wang JJ, Mitchell P, et al. Risk of age-related macular
degeneration 3 years after cataract surgery: Paired eye
comparisons. Ophthalmology 119(11): 2298-2303, 2112
Blue Mountains Eye Study cases
baseline
after 5 years
after 10 years
AMD and Cataract Surgery
 Cataract is the major cause of visual impairment in older
persons; AMD is principal cause of blindness
 Cataract surgery -most frequently performed operation in
many countries; arguably the most successful
 No association found between AMD and cataract in
population-based studies
 Series of case reports suggested a link between cataract
surgery and progression to NV-AMD
Cataract Surgery and AMD
 Pooled findings 2 population cohorts (BDES, BMES)
suggested cataract surgery may be associated with
substantially higher risk of late AMD
 Risk of developing AMD in eyes already operated at
baseline 3-5 times than in phakic eyes of persons with
similar age, gender, smoking, early ARM signs
 odds ratio 4.9 (1.9-12.4) for NV AMD
 odds ratio 4.5 (1.4-14.7) for GA
 Risk appears longer-term
 Important implications; studies of mechanisms needed
Wang, et al Ophthalmology 2003, GEE analysis
Recent Data: Ophthalmol Nov 2012 Wang et al
 We followed consecutive cataract surgical patients recruited at
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Westmead Hospital in Sydney, Australia into the Cataract
Surgery & Age-related Macular Degeneration (CSAMD) Study
– 2029 eligible participants
Incident early AMD defined as: new appearance of soft
indistinct drusen or co-existing retinal pigmentary changes and
soft distinct drusen in eyes at risk of early AMD. Incident late
AMD defined as: new appearance of neovascular AMD or
geographic atrophy (GA) in eyes at risk of late AMD
1851/ 2029 pts had surgery; 70.4% had 3-year post-op visits
Of 308 who had unilateral cataract surgery at risk of late AMD,
this developed in 4 (1.3%) & 7 (2.3%) non-operated fellow
eyes, odds ratio (OR) 0.74, CI 0.74-1.65), adjusting for
presence of early AMD at baseline
Of 217 who had unilateral cataract surgery at risk of early
AMD, this developed in 23 (10.6%) & 21 (9.7%) non-operated
fellow eyes (OR 1.07, CI 0.74-1.65)
Recent Data: Ophthalmol Nov 2012 Wang et al
 Incident RPE abnormalities were more frequent in operated
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than non-operated fellow eyes (15.9% vs 9.9%, OR 1.64, CI
1.07-2.52)
There was no difference in 3-year incidence of large soft
indistinct or reticular drusen between the 2 eyes (8.8% vs
7.9%, OR 1.12, CI 0.79-1.60)
Prospective follow-up data & paired eye comparisons of this
surgical cohort showed no increased 3-Y risk of developing
late AMD/ early AMD signs. There was a 60% increased
detection of RPE changes in surgical eyes
Distribution of early AMD lesions was more frequent among
persons undergoing cataract surgery than among age peers in
the older population
This study provides a partial explanation for the inconsistent
observations on possible links between cataract surgery &
AMD from population vs clinic-based studies
Conclusions
 Incid