Navigate cataract surgery for those with AMD. Learn about key considerations for better treatment results.
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My dad was recently diagnosed with a secondary cataract – five years after his initial cataract surgery. He was scheduled to see the doctor who performed his first surgery to address this issue. This experience reminded me of some of the important learning about the connection between cataracts and age-related macular degeneration (AMD).
In this first of the two-part article series, we'll dive into the learning and considerations from a few years back. In the second part, we'll talk about our recent experience with secondary cataracts and our findings.Â
Whether you're living with these conditions or know someone who is, join us in exploring the complexities of treating cataracts for individuals with macular degeneration.
How are cataracts and age-related macular degeneration connected?
As we age, our eyes undergo changes that can affect our vision, including age-related eye conditions, such as cataracts and AMD.Â
“Cataract” means “waterfall” in Greek because when the lens becomes cloudy it's like looking through a waterfall.
Cataracts occur when the clear lens in the front of the eye becomes cloudy and results in the scattering or reduction of light reaching the retina, leading to problems seeing clearly. Cataracts are painless and can develop slowly over many years. While early development may not cause noticeable symptoms, they can progress rapidly over time.
Unfortunately, cataracts do not improve on their own. If left untreated, cataracts can significantly impact your daily life, making it challenging to perform tasks such as reading or driving.[1]
AMD is a chronic disease that affects the macula, which is in the back of the eyes and responsible for central vision. As retina cells in the macula deteriorate slowly, it causes blurred or reduced central vision. In late-stage AMD, most central vision is lost, and people become highly dependent on their peripheral vision – which is an important factor to consider when treating cataracts. (Learn more about Macular Degeneration)
Both cataracts and AMD are more prevalent as we age and often occur together. A recent study found that one out of five people over 50 listed for cataract surgery had some evidence of AMD.
Will cataract surgery cause AMD progression?
The question of whether cataract surgery can cause AMD progression has been a long-standing debate among researchers and clinicians. As my dad had both cataracts and AMD, I was concerned about the potential risks associated with cataract surgery.
Despite my concerns, after consulting with his doctor, we decided to proceed with the surgery. We were encouraged by the potential benefits of his vision and quality of life improvement.[2] And we also took comfort in the fact that the absolute risk of AMD progression after cataract surgery is relatively low. [5,6]
After the surgery, my dad started noticing an increase in AMD symptoms, such as distortion and blurring of his central vision. However, this was not unexpected, as his cataracts had been masking the AMD symptoms. Removing the cataract allowed the underlying AMD to become more apparent, making his symptoms more noticeable.
It's worth noting that when my dad underwent cataract surgery, there was not as much evidence available on the potential association between cataract surgery and AMD progression as there is today. In recent years, several large studies, including the Age-Related Eye Disease Study (AREDS), have been conducted to investigate this issue, and the results have been largely reassuring. Researchers found no significant association between cataract surgery and an increased risk of AMD. [3,4,7,8]
Treating cataracts if you also have AMD
The first line of treatments for early-stage cataracts is usually non-surgical measures, including new glasses, brighter lighting, antiglare sunglasses, or magnifying lenses. However, if left untreated, cataracts can harden and become more difficult to remove. It can lead to significant vision loss over time. The rate can vary, but it's important to address the issue before it progresses too far.
In most cases, cataracts can be treated effectively with surgery. Cataract surgery is quick and relatively painless, and it involves removing the clouded lens and replacing it with an artificial intraocular lens (IOL).Â
There are several types of IOL, such as monofocal, accommodating, toric, aspheric, and others. However, multifocal intraocular lenses are not likely to work well for people with AMD, as they split light rays leading to a decrease in the amount of light that reaches the retina, leading to a reduced improvement in visual function. [1]
Nowadays, cataract surgery usually takes less than 30 minutes and is performed under local anesthesia with some sedation. Recovery time is usually quite rapid, although full recovery can take up to 8 weeks. It's important to follow your eye doctor’s instructions carefully during the recovery period and to contact them immediately if you experience side effects or discomfort.
If you have cataracts in both eyes, each eye will usually be treated on separate days, often weeks apart. This allows time for one eye to heal before surgery is performed on the other eye. In general, the best outcomes are achieved when both eyes are treated.
Special considerations for people with retina conditions
If you have a retinal condition or AMD and are considering cataract surgery, it's crucial to be informed about the important factors to consider.Â
If you're undergoing anti-VEGF treatment, it's advisable to wait until your eye has stabilized before undergoing cataract surgery. According to a study by the Fight Retinal Blindness registry, people who underwent cataract surgery within six months of starting anti-VEGF treatment had a higher likelihood of worse treatment results and recommended avoiding it if possible. [9]
Another consideration is vitrectomy surgery, which can worsen existing cataracts or cause new ones to develop. If you need a vitrectomy to treat conditions, such as retinal detachment, macular pucker, or eye floaters, your surgeon may suggest having both the cataract and vitrectomy done at the same time to avoid the need for another operation.
Cataract treatment can be complex, especially if you have other eye conditions, so it's crucial to discuss it with your eye doctor. With careful planning and consideration of these special factors, you can achieve the best possible outcomes from your cataract surgery and other eye treatments.
What are the potential complications of cataract surgery?
Cataract surgery is generally safe and effective, but it can have some potential complications. Some of these complications can happen right after surgery, like discomfort, swelling, and pressure in the eye. Patients should monitor these symptoms and seek medical attention if they get worse.
A long-term consequence of cataract surgery is a secondary cataract, also known as posterior capsule opacification (PCO). This happens when the back part of the lens capsule becomes cloudy and impairs vision, similar to how a cataract can affect your vision. (This is what my dad developed, five years after his initial cataract surgery.)
Other severe but rare complications include damage to the back part of the lens, swelling of the retina, retinal tear or detachment, and infections in the eye. These complications can cause severe vision loss, so it's important to take precautions and monitor the symptoms closely.
Key takeaways
As we've learned, cataracts and AMD are two common eye conditions that often occur together as we age. For those with AMD, it's important to understand the factors to consider when deciding whether to undergo cataract surgery. Fortunately, studies have shown that cataract surgery can improve vision in eyes with AMD, as well as improve peripheral vision and decrease the risk of falls.
While cataract surgery is generally safe and effective, there are potential complications to be aware of, such as the development of a secondary cataract, which we will discuss in the next article.
Moreover, it’s essential to talk to your eye doctor about the special considerations that must be taken into account for those with retina conditions or undergoing anti-VEGF treatment.
With proper treatment and care, you can maintain good vision and enjoy a better quality of life.
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