Abstract
Cataract and age-related macular degeneration (AMD) are two of the most common eye diseases of aging. This review addresses the pre-operative, intra-operative, and post-operative considerations in managing cataract in patients with age-related macular degeneration. Surgery for visually significant cataracts in patients with AMD can substantially improve the quality of life and reduce the risk of falls. Pre-operative optical coherence tomography is now recommended where possible to identify pre-existing macula disease. Careful counselling of patients is required before cataract surgery, especially with respect to the expected visual outcome, intraocular lens choice and potential risks of surgery. Real-world data has suggested 6 months of intravitreal anti-VEGF therapy for neovascular AMD before cataract surgery is compatible with optimum long-term visual outcomes. Patients receiving intravitreal therapy for neovascular AMD should be advised of the slightly higher risk of intraoperative complications and the surgeon should be prepared to manage these during the operation. During cataract surgery, unnecessary light exposure should be avoided to reduce phototoxicity. Careful planning of intravitreal therapy for neovascular AMD just before cataract surgery allows the eye greater recovery time in the post-operative period before further planned intravitreal therapy.
Highlights
Cataract and age-related macular degeneration (AMD) are two of the most common causes of visual impairment globally, with the incidence set to increase in upcoming decades with an ageing population [1]
This review provides guidance on the pre-operative, intra-operative, and post-operative considerations in managing cataracts in patients with age-related macular degeneration (Table 1)
It concluded that cataract surgery provides improvement in vision in eyes with AMD compared with no surgery at six months, it is unclear whether the timing of surgery has an effect on longer-term visual outcomes
Summary
Cataract and age-related macular degeneration (AMD) are two of the most common causes of visual impairment globally, with the incidence set to increase in upcoming decades with an ageing population [1]. A recent study in patients over 50 years of age identified that 20% of 411 eyes listed for cataract surgery had some evidence of AMD on optical coherence tomography (OCT) imaging [2]. This review provides guidance on the pre-operative, intra-operative, and post-operative considerations in managing cataracts in patients with age-related macular degeneration (Table 1). Evidence is derived from available clinical trials, real-world evidence and expert opinion.
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