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Is it Safe to Have Cataract Surgery with Macular Degeneration?

When the lens of the eye gets clouded, it is called a cataract. A cataract blocks the ability of light to pass through the lens and to the retina where clear images can be perceived. Therefore, when you have a cataract, your vision is blurry. This blurriness can greatly impact vision, especially if there are other conditions present. Cataracts mainly occur in older adults, from 50-80 years of age and older. Since they occur mainly in older individuals, they can occur alongside age-related macular degeneration (AMD).1

How are cataracts treated?

Sometimes cataracts can be treated with visual aids, like new glasses, special sunglasses, better lighting, and magnifiers. However, if cataracts are more severe and not improved by these measures, surgery may be needed. Cataract surgery involves making a small incision on the front of eye using lasers or ultrasound. The clouded lens is removed from the eye and a new artificial lens is put in. Cataract surgery is considered safe and effective for those who are good candidates for the procedure.1,2

Cataract surgery and macular degeneration

There have been mixed results regarding cataract surgery on individuals with AMD. On the surface, it seems like cataract surgery shouldn’t impact AMD, since cataracts are on the lens on the front of the eye and AMD affects the retina at the back of the eye.

Risks

However, some experts have suggested that cataract surgery could make AMD worse, specifically due to the inflammation created during the procedure. Others have suggested that the new artificial lens might not protect as well from certain wavelengths of light that could worsen AMD. However, as time has gone on, improvements in the cataract surgical procedure itself, and new, potentially more protective lenses have been developed, which may help further reduce risks.2-8

Benefits or no effect

Current research suggests that in some cases, cataract surgery may be beneficial for those with AMD, and at worst, may have no effect. Relatively little information suggests that cataract surgery in individuals with AMD will worsen AMD. However, most studies that currently exist on the topic have a relatively short follow-up period. More long-term research is needed to determine the lasting effects of cataract surgery on AMD.2-8

Considerations

The main considerations made, when determining whether or not an individual with AMD should have cataract surgery, is whether or not the procedure will actually help their vision. In some cases, AMD may be severe, and removing a cataract will have no impact on overall vision. It would be unnecessary for someone to have the surgery if it’s not going to have an effect. In order to determine whether your vision might improve with the removal of a cataract, your physician may first try vision aids, like brighter lighting or special magnifiers. They will also look at your eye, test your vision, and take special photos if needed to determine how much, if any, your vision might change after surgery.1,2

Can I have cataract surgery if I have dry AMD?

Since dry AMD is the most common form of AMD, there seems to be more information available on its relationship with cataract surgery than other forms. At this time, dry AMD does not seem to worsen with cataract surgery. Cataract surgery is generally considered safe in these situations. However, more long-term research is needed, and post-surgery vision improvements may vary based on individual situations.2-7 Your physician will determine if you are a candidate for cataract surgery with your dry AMD.

Can I have cataract surgery if I have wet AMD?

The relationship between wet AMD and cataract surgery is less understood. Some experts are concerned with the inflammation and leaky vessels that can arise after cataract surgery which may make wet AMD worse. Additionally, it is unclear how newer, wet AMD treatment options, called anti-VEGF therapies, might impact cataract surgery. Although past information has been inconsistent, recent research suggests that it is safe for individuals with wet AMD and who are on anti-VEGF therapy to have cataract surgery. Just like with dry AMD, results may vary, and not every individual’s case may benefit from cataract surgery. More long-term information is needed to determine the true benefits or risks.3,4,8 Your physician will evaluate your situation, current treatment options, and extent of both your AMD and cataracts, and will determine if you are a candidate for surgery.

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  1. Facts About Cataract. National Institutes of Health: National Eye Institute. https://nei.nih.gov/health/cataract/cataract_facts. Published September 2015. Accessed May 10, 2019.
  2. Dunaief J. Cataracts and Age-Related Macular Degeneration. BrightFocus Foundation. https://www.brightfocus.org/macular/article/cataracts-and-age-related-macular. Published October 24, 2018. Accessed May 10, 2019.
  3. Boyd K. Degeneration and Cataract Surgery: Are They Compatible? American Academy of Ophthalmology. https://www.aao.org/eye-health/tips-prevention/macular-degeneration-cataract-surgery-are-they-com. Published January 27, 2019. Accessed May 10, 2019.
  4. Ehmann D, Ho A. Cataract surgery and age-related macular degeneration. Current Opinion in Ophthalmology. Jan 2017; 28(1), 58-62.
  5. Armbrecht AM, Findlay C, Kaushal S, et al. Is cataract surgery justified in patients with age related macular degeneration? A visual function and quality of life assessment. British Journal of Ophthalmology. 2000; 84, 1343-1348.
  6. Cataract Surgery in People with Age-Related Macular Degeneration. The Cochrane Collaboration. https://www.cochrane.org/CD006757/EYES_cataract-surgery-people-age-related-macular-degeneration. Accessed May 10, 2019.
  7. Qian X, Young LH. The impact of cataract surgery on AMD development and progression. Seminars in Ophthalmology. 2014; 29(5-6), 301-311.
  8. Starr MR, Mahr MA, Barkmeier AJ, et al. Outcomes of cataract surgery in patients with exudative age-related macular degeneration and macular fluid. American Journal of Ophthalmology. Aug 2018; 192, 91-97.

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