Risk of Advanced Age-Related Macular Degeneration after Cataract Surgery in the Age-Related Eye Disease Study: AREDS Report 25

doi:10.1016/j.ophtha.2008.09.019

Ophthalmology

Volume 116, Issue 2, February 2009, Pages 297-303

https://doi.org/10.1016/j.ophtha.2008.09.019 Get rights and content

Purpose

To assess the risk of advanced age-related macular degeneration (AMD) developing after cataract surgery.

Design

Cohort study.

Participants

Four thousand five hundred seventy-seven participants (8050 eyes) from a multicenter, controlled, randomized clinical trial, the Age-Related Eye Disease Study (AREDS).

Methods

Development of advanced AMD, either neovascular (NV) AMD or geographic atrophy (GA), was evaluated with annual fundus photographs, and history of cataract surgery was assessed every 6 months. Cox proportional hazard models with time-dependent covariates were conducted for NV AMD and GA separately.

Main Outcome Measures

Neovascular AMD, GA, and central GA (CGA; involving the center of the macula).

Results

The Cox proportional hazards model of right eyes showed nonsignificant hazard ratios of 1.20 (95% confidence interval [CI], 0.82–1.75) for NV AMD, 0.80 (95% CI, 0.61–1.06) for GA, and 0.87 (95% CI, 0.64–1.18) for CGA. Similar results were obtained for left eyes: 1.07 (95% CI, 0.72–1.58) for NV AMD, 0.94 (95% CI, 0.71–1.25) for GA, and 0.86 (95% CI, 0.63–1.19) for CGA. For participants with advanced AMD in 1 eye (AREDS category 4), the hazard ratios for fellow eyes were 1.08 (95% CI, 0.65–1.72) for NV AMD and 0.98 (95% CI, 0.64–1.49) for CGA.

Conclusions

The AREDS results showed no clear effect of cataract surgery on the risk of progression to advanced AMD.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

Details of the study design and methods, presented elsewhere,¹⁶ are briefly summarized here. Eleven retinal specialty clinics enrolled 4757 participants in the AREDS from 1992 through 1998. Participants were 55 through 80 years of age at enrollment and had best-corrected visual acuity (VA) of 20/32 or better in at least 1 eye (the study eye[s]). Media had to be sufficiently clear to obtain adequate quality stereoscopic fundus photographs of the macula in all study eyes. VA was assessed by

Results

Table 1 gives the distribution of baseline characteristics for participants with and without cataract surgery. Risk of advanced AMD associated with cataract surgery is summarized in Table 2 and Figure 1 and is given in detail below.

Discussion

The results from the Cox proportional hazards models used to examine AREDS data show little evidence of a detrimental effect of cataract surgery on progression to advanced AMD. Use of the Cox regression model allows us to take advantage of a unique feature of AREDS, the ability to examine the effect of important covariates, including time-dependent covariates, on progression to late AMD. Results from the Cox models are not statistically significant and there are no consistent trends among

Acknowledgments

The authors thank Molly Harrington, MA, Jonghyeon Kim, PhD, and Martin Ho, MS, of the EMMES Corporation for extensive statistical assistance.

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Cited by (129)

Cataract Surgery and the Risk of Developing Late Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 Report Number 27
2022, Ophthalmology
To evaluate the risk of developing late age-related macular degeneration (AMD) after incident cataract surgery.
A prospective cohort study within a randomized controlled clinical trial of oral supplementation for the treatment of AMD, the Age-Related Eye Disease Study 2 (AREDS2).
AREDS2 participants aged 50 to 85 years with bilateral large drusen or unilateral late AMD.
In eyes free of cataract surgery and late AMD at baseline, 2 groups were compared for incident late AMD: (1) eyes that received cataract surgery after the baseline visit and before any evidence of late AMD and (2) eyes that remained phakic until study completion. Eyes with at least 2 years of follow-up after cataract surgery were included in the analysis. We used Cox regression models, matched-pairs analysis, and logistic regression models that were adjusted for age, sex, smoking, education, study treatment group, and AMD severity.
Late AMD was defined as the presence of geographic atrophy or neovascular AMD detected on annual stereoscopic fundus photographs or as documented by medical records, including intravitreous injections of anti-vascular endothelial growth factor medication.
A total of 1767 eligible eyes (1195 participants) received cataract surgery; 1981 eyes (1524 participants) developed late AMD during a mean (range) follow-up of 9 (1–12) years. The Cox regression model showed no increased risk of developing late AMD after cataract surgery: hazard ratio, 0.96; 95% confidence interval (CI), 0.81–1.13 (P = 0.60) for right eyes and hazard ratio, 1.05; 95% CI, 0.89–1.25 (P = 0.56) for left eyes. Of the matched pairs, late AMD was identified in 408 eyes that received cataract surgery and in 429 phakic controls: odds ratio (OR) 0.92 (95% CI, 0.77–1.10; P = 0.34). The risk of late AMD after cataract surgery from the logistic regression model was not statistically significant (risk ratio, 0.92; 95% CI, 0.56–1.49; P = 0.73).
Cataract surgery did not increase the risk of developing late AMD among AREDS2 participants with up to 10 years of follow-up. This study provides data for counseling AMD patients who might benefit from cataract surgery.
Effect of Blue Light-Filtering Intraocular Lenses on Age-Related Macular Degeneration: A Nationwide Cohort Study With 10-Year Follow-up
2022, American Journal of Ophthalmology
Citation Excerpt :
Their study also demonstrated an association between cataract surgery and exudative AMD during a 5‐year follow-up period. However, this link was ambiguous, and some studies did not support it.38-40 There are several plausible explanations for the association between cataract surgery and exudative AMD, including cataract surgery-related inflammation, environmental photic retinopathy, and genetic factors.
To determine the incidence rate of age-related macular degeneration (AMD) after cataract surgery and compare the relative incidence of AMD in pseudophakes with blue light-filtering intraocular lenses (BF-IOLs) and non–BF-IOLs.
A nationwide cohort study conducted using the Taiwan National Health Insurance Research Database.
We enrolled 186,591 patients who underwent cataract surgery in both eyes between 2008 and 2013 and monitored them from the index date (the date of first cataract surgery) until AMD, death, loss to follow-up, or December 31, 2017, whichever occurred first. Propensity score matching (PSM) was used to balance the baseline characteristics between the BF-IOL and non–BF-IOL groups.
BF-IOLs were implanted in 21,126 patients (11.3%) and non–BF-IOLs were implanted in 165,465 patients (88.7%). Patients in the BF-IOL group tended to be younger, with fewer men, different cataract surgery years, higher income, more nonmanual workers, more patients from urban and suburban areas, and fewer chronic diseases compared with the non–BF-IOL group. With a mean follow-up period of 6.1 years (range, 1-10 years) after cataract surgery, 12,533 and 1655 patients developed non-exudative AMD and exudative AMD, respectively. The incidence rate of non-exudative AMD and exudative AMD (per 1000 person-years) was 9.95 and 1.22 for the BF-IOL group and 11.13 and 1.44 for the non–BF-IOL group, respectively. After PSM, no statistical difference in the incidence rate of nonexudative AMD (hazards ratio, 0.95; 95% CI, 0.88-1.03) and exudative AMD (hazard ratio, 0.96; 95% CI, 0.77-1.18) was observed between the BF-IOL and non–BF-IOL groups.
In Taiwan, the incidence rate of AMD after cataract surgery was 11.59 per 1000 person-years. The use of a BF-IOL for up to 10 years had no apparent advantage over a non–BF-IOL in the incidence of AMD.
Visual outcomes following cataract surgery in age-related macular degeneration patients
2021, Canadian Journal of Ophthalmology
To evaluate visual acuity (VA) outcomes, prognostic factors, and changes in disease severity in patients with age-related macular degeneration (AMD) undergoing cataract surgery.
Retrospective cohort study
Patients with AMD or healthy control patients who underwent cataract surgery between 2012 and 2017.
Eyes were categorized into 3 AMD groups—intermediate AMD (iAMD), fovea-involving geographic atrophy (GA), neovascular AMD (nAMD)—and 3 preoperative VA-matched control groups (iAMDc), fovea-involving geographic atrophy control (GAc), neovaascular AMD control (nAMDc).
We compared 216 iAMD, 35 GA, and 184 nAMD eyes with 130, 31, and 129 controls. At postoperative month 12 (POM12), VA increased significantly in iAMD and nAMD (+10.1 ± 14.5 and +9.7 ± 18.9 letters, p < 0.001), but not in GA (p = 0.68). All control groups showed significant VA gains (iAMDc: +17.1 ± 9.7, GAc: +30 ± 12.9, and nAMDc: +26.4 ± 15.6 letters, p < 0.001). For AMD groups, POM12 VA and gain in VA were significantly lower than that of controls (p < 0.01), and better preoperative VA predicted smaller VA gains (p ≤ 0.007). Longer duration of AMD in iAMD, ellipsoid zone disruption in nAMD, and lower central subfield thickness in GA were associated with poorer VA outcomes (p < 0.05). Development of nAMD occurred in 8 iAMD eyes and was associated with longer duration of disease (p = 0.001). For nAMD eyes, injection frequency did not vary between the 12-month pre- and postoperative periods (p = 0.051).
Cataract surgery improves VA for patients with iAMD and nAMD, albeit not to the level of those without retinal pathology. Preoperative VA, AMD duration, and optical coherence tomography parameters may be important prognostic factors for cataract surgery in patients with AMD.
Évaluer les résultats en matière d'acuité visuelle (AV), les facteurs pronostiques et l’évolution de la gravité de l'affection après une chirurgie de la cataracte chez des patients présentant une dégénérescence maculaire liée à l’âge (DMLA).
Étude de cohorte rétrospective.
Patients présentant une DMLA et sujets sains qui ont tous subi une chirurgie de la cataracte entre 2012 et 2017.
Les yeux ont été séparés en 3 groupes en fonction du type de DMLA : DMLA intermédiaire (DMLAi), atrophie géographique (AG) touchant la fovéa et DMLA néovasculaire (DMLAn). Chaque groupe DMLA a été jumelé à un groupe témoin (t) apparié en matière d'AV préopératoire: DMLAit, AGt, DMLAnt.
Nous avons comparé 216 yeux DMLAi, 35 yeux AG et 184 yeux DMLAn à 130 yeux, 31 yeux et 129 yeux témoins, respectivement. Au 12^e mois postopératoire (12MPO), l'AV avait augmenté significativement dans les groupes DMLAi et DMLAn (+10,1 ± 14,5 et +9,7 ± 18,9 lettres; p < 0,001), mais pas dans le groupe AG (p = 0,68). Les yeux dans tous les groupes témoins ont présenté des améliorations significatives de l'AV (DMLAit: +17,1 ± 9,7; AGt : +30 ± 12,9 et DMLAnt: +26,4 ± 15,6 lettres; p < 0,001). Par ailleurs, l'AV à 12MPO et les améliorations de l'AV étaient significativement moindres dans les groupes DMLA que dans les groupes témoins (p < 0,01); de même, on a noté un lien entre une AV préopératoire supérieure et une amélioration moindre de l'AV postopératoire (p ≤ 0,007). L'ancienneté de la DMLA dans la DMLAi, l'altération de la zone ellipsoïde dans la DMLAn et un épaississement du sous-champ central inférieur dans l'AG s'accompagnaient de résultats plus médiocres en matière d'AV (p < 0,05). Il s'est produit une DMLAn dans 8 yeux DMLAi, phénomène qui était lié à la présence d'une atteinte plus ancienne (p = 0,001). La fréquence d'injection dans le groupe DMLAn n'a pas varié entre les 2 périodes (12 mois avant l'intervention et 12MPO; p = 0,051).
La chirurgie de la cataracte améliore l'AV des patients présentant une DMLAi ou une DMLAn, mais pas autant que chez les patients sans atteinte de la rétine. L'AV préopératoire, l'ancienneté de la DMLA et les paramètres de la tomographie par cohérence optique peuvent s'avérer des facteurs pronostiques importants lors de la chirurgie de la cataracte en présence de DMLA.
The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Neovascular Age-Related Macular Degeneration
2021, Ophthalmology
To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery.
Cohort study.
Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland.
Subsequent nAMD rates were compared between patients who received BLF IOLs and those who received non-BLF IOLs. Kaplan-Meier and Cox regression analyses for the overall risk of nAMD developing were assessed. Best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections were secondary outcomes. A separate analysis was performed on patients with pre-existing nAMD to assess the effect of BLF IOLs on nAMD progression. A single eye of each patient was included.
Neovascular age-related macular degeneration-free survival.
Included were 11 397 eyes of 11 397 patients with a mean age of 75.4 ± 8.3 years (62.5% women). The BLF IOL was used in 5425 eyes (47.6%), and the non-BLF IOL was used in 5972 eyes (52.4%). During follow-up (BLF IOL group, 55.2 ± 34.1 months; non-BLF IOL group, 50.5 ± 30.1 months; P < 0.001), 164 cases of new-onset nAMD were recorded (BLF group, n = 88; non-BLF group, n = 76). The nAMD-free survival was similar between the groups (P = 0.465, log-rank test). In a Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration, the use of a BLF IOL was not predictive of nAMD development (hazard ratio [HR], 1.075; 95% confidence interval [CI], 0.79–1.47; P = 0.652). In nAMD patients, secondary clinical outcomes at 1 year were comparable for BCVA (0.57 ± 0.4 logarithm of the minimum angle of resolution vs. 0.45 ± 0.4 logarithm of the minimum angle of resolution; P = 0.136), foveal thickness (285 ± 109 μm vs. 299 ± 103μm; P = 0.527), number of anti–vascular endothelial growth factor injections (6.5 ± 2.5 vs. 6.2 ± 2.7; P = 0.548), and treatment interval (7.5 ± 2.4 weeks vs. 8.1 ± 2.4 weeks; P = 0.271) for BLF and non-BLF IOLs, respectively. Similarly to patients in whom nAMD developed after the surgery, among patients with nAMD before surgery (BLF, n = 71; non-BLF, n = 74), the clinical outcomes again were comparable (all P > 0.05).
In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.
Epidemiology of geographic atrophy and its precursor features of intermediate age-related macular degeneration
2023, Acta Ophthalmologica
Prevalence of age-related macular degeneration and associated factors in Indian cohort in a tertiary care setting
2023, Indian Journal of Ophthalmology

View all citing articles on Scopus

: Manuscript no. 2008-701.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported by contracts from the National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.

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Original articleRisk of Advanced Age-Related Macular Degeneration after Cataract Surgery in the Age-Related Eye Disease Study: AREDS Report 25

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Study Population

Results

Discussion

Acknowledgments

Am J Ophthalmol

Ophthalmology

J Cataract Refract Surg

Am J Ophthalmol

Ophthalmology

Ophthalmology

Causes and prevalence of visual impairment among adults in the United States

Arch Ophthalmol

The relationship of ocular factors to the incidence and progression of age-related maculopathy

Arch Ophthalmol

Cataract and age-related maculopathy: the Blue Mountains Eye Study

Ophthalmic Epidemiol

Is age-related maculopathy associated with cataracts?

Arch Ophthalmol

The association of age-related macular degeneration and lens opacities in the aged

Am J Public Health

Original article
Risk of Advanced Age-Related Macular Degeneration after Cataract Surgery in the Age-Related Eye Disease Study: AREDS Report 25