Visual acuity after cataract surgery in patients with age-related macular degeneration: age-related eye disease study 2 report number 5.

Publication Type
Journal Article
Year of Publication
Age-Related Eye Disease Study 2 Research Group; Huynh, Nancy; Nicholson, Benjamin P; Agrón, Elvira; Clemons, Traci E; Bressler, Susan B; Rosenfeld, Philip J; Chew, Emily Y
Date Published
2014 Jun
Aged; Aged, 80 and over; cataract; Cohort Studies; Dietary Supplements; Fatty Acids, Omega-3; Female; Humans; Lens Implantation, Intraocular; Lutein; Macular Degeneration; Male; Middle Aged; Phacoemulsification; Prospective Studies; Pseudophakia; Severity of Illness Index; visual acuity; Vitamins; Xanthophylls; Zeaxanthins

OBJECTIVE: To evaluate visual acuity outcomes after cataract surgery in persons with varying degrees of severity of age-related macular degeneration (AMD).

DESIGN: Cohort study.

PARTICIPANTS: A total of 1232 eyes of 793 participants who underwent cataract surgery during the Age-Related Eye Disease Study 2, a prospective, multicenter, randomized controlled trial of nutritional supplements for treatment of AMD.

METHODS: Preoperative and postoperative characteristics of participants who underwent cataract extraction during the 5-year trial were analyzed. Both clinical data and standardized red-reflex lens and fundus photographs were obtained at baseline and annually. Photographs were graded by a centralized reading center for cortical and posterior subcapsular lens opacities and for AMD severity. Cataract surgery was documented at annual study visits or by history during the 6-month telephone calls. Analyses were conducted using multivariate repeated-measures regression.

MAIN OUTCOME MEASURES: Change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA.

RESULTS: Adjusting for age at time of surgery, gender, interval between preoperative and postoperative visits, and type and severity of cataract, the mean changes in visual acuity were as follows: eyes with mild AMD (n = 30) gained 11.2 letters (95% confidence interval [CI], 6.9-15.5), eyes with moderate AMD (n = 346) gained 11.1 letters (95% CI, 9.1-13.2), eyes with severe AMD (n = 462) gained 8.7 letters (95% CI, 6.7-10.7), eyes with noncentral geographic atrophy (n = 70) gained 8.9 letters (95% CI, 5.8-12.1), and eyes with advanced AMD (central geographic atrophy, neovascular disease, or both; n = 324) gained 6.8 letters (95% CI, 4.9-8.8). The visual acuity gain across all AMD severity groups was statistically significant from preoperative values (P < 0.0001).

CONCLUSIONS: Mean visual acuities improved significantly after cataract surgery across varying degrees of AMD severity.