Does cataract surgery make macular degeneration worse?
Many of my patients who undergo cataract surgery also have macular degeneration. This is not surprising given that both conditions are more likely to develop as we get older.
There is one common question for patients and a concern for eye surgeons. This question concerns whether undergoing cataract surgery can worsen co-existent macular degeneration.
Two types of macular degeneration exist: dry macular degeneration and wet macular degeneration. Dry macular degeneration refers to the ‘wear and tear’ ageing of the central part of the retina. This part is also known as the macula. To date, we have no effective treatment to reverse dry macular degeneration. We have discussed a future preventative treatment known as lampalizumab in a previous blog post.
If you have dry age related macular degeneration, there is no evidence that cataract surgery will make your dry macular degeneration worse. If your macular degeneration is advanced, the cataract surgery will allow more light to enter the eye. The surgery may not improve the fine vision for tasks such as reading and recognizing faces. This is because we need a combination of a clear lens and a healthy retina to be able to see clear. Treating one is not enough to improve the eyesight in some patients.
Wet macular degeneration is caused by the abnormal growth of blood vessels under the macula. This can cause localized swelling and bleeding within the retina. Furthermore, that can affect the central vision with patients reporting central blur or distortion. Intravitreal injections were injected into the back of the eye. The injection is blocking the growth of these blood vessels and restores the retinal structure and function. As a result, the central blur or the distortion should be cleared.
There was a concern that patients who undergo cataract surgery may make wet macular degeneration worsen if they have it already. The mechanism of this is uncertain. We do know that inflammatory molecules are released at the time of cataract surgery. That could have a potential negative effect on wet macular degeneration.
In clinical practice this is uncommon. One recent study (see reference at bottom) from the USA has also showed that vision does improve after patients have cataract surgery. There was no need for increasing their treatment for wet macular degeneration if they were on it.
There is no evidence that cataract surgery will make it more likely to for patients to develop dry or wet macular degeneration either.
Patients who have stable wet age-related macular degeneration should have a close period of monitoring after their cataract surgery. This monitoring reassures them that there is no reactivation of their condition and to restart intravitreal injections if necessary.
If you would like to chat further about any aspect of cataract surgery or age-related macular degeneration, please feel free call me on 020 7952 2826.
Saraf SS, et al. Am J Ophthalmol. 2015;doi:10.1016/j.ajo.2015.06.006