Feb 08, 2009
A recent study published in the journal Ophthalmology, revealed that cataract surgery may not increase the risk of progression of advanced age-related macular degeneration (AMD.). The authors used data from the well known Age-Related Eye Disease Study (AREDS.) For many years, cataract surgeons like myself, have cautioned our patients, that we have seem patients that have had worsening of their AMD after cataract surgery but there has never been a direct link. Previous studies have suggested, that the AMD has a propensity to get worse over time with or without cataract surgery. This recent study appears to confirm the general concensus that the AMD needs to followed closely, regardless of whether or not cataract surgery is performed and while some patients may show worsening of the AMD down the road, it statistically not related to cataract surgery as far as we know.
For my part, I always have this discussion with cataract surgery patients who have AMD. I also make sure they are on the appropriate anti-oxidant vitamins, omega 3 fish oil, lutein, and a diet rich in green leafy vegetables like spinach and brocolli. For patients with advanced AMD, I usually use the Acrysof IQ lens which filters UV light and some of the harmful blue light at the very, very end of the visible light spectrum. It is the only IOL that does that and it might have a slightly better protective effect than other IOL's (although no proof yet, long term.) If possible, I also use the very lowest light power on the operation microscope, try to limit the surgery to less than 8-10 minutes. Simple little things with no proven benefit but worth the effort I think.
I have one patient that I think of often who was already at 20/400 vision due to end stage AMD in the right eye and moderate AMD in the left eye with a very cloudy, mature cataract. I have him on AREDS formula vitamins, Lutein and Omega 3 fish oil and a proper diet. It has been about 5 years since we removed the cataract in the left eye and used the Acrysof lens (with the extra chromophore filter) and he maintains 20/20 vision in that eye and often brings in the very heartfelt poetry that he writes and publishes. You see he is a WWII veteran and is a strong patriot. His works of poetry get to me every time and I think the world of him.
Michael Kutryb, MD