Cataract Surgery and the Risk of Developing Late Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 Report Number 27.

Abstract Purpose To evaluate the risk of developing late age-related macular degeneration (AMD) following incident cataract surgery. Design A prospective cohort study within a randomized controlled clinical trial of oral supplementation for the treatment of AMD - the Age-Related Eye Disease Study 2 (AREDS2). Participants AREDS2 participants aged 50 to 85 years with either bilateral large drusen or unilateral late AMD. Methods In eyes that were free of cataract surgery and late AMD at baseline, two groups were compared for incident late AMD: 1) eyes that received cataract surgery after the baseline visit and before any evidence of late AMD and 2) eyes that remained phakic until the study completion. Eyes that had at least 2 years of follow-up after cataract surgery were included in the analysis. We used Cox regression models, matched-pairs analysis, and logistic regression models that were adjusted for baseline age, sex, smoking, education, study treatment group, and AMD severity. Main outcome measures Late AMD was defined as the presence of geographic atrophy or neovascular AMD detected on annual stereoscopic fundus photographs or as documented by medical records, including intravitreous injections of anti-vascular endothelial growth factor medication. Results A total of 1767 eligible eyes (1195 participants) received cataract surgery and 1981 eyes (1524 participants) developed late AMD during a mean (range) follow-up of 9 (1 – 12) years. The Cox regression model showed no increased risk of developing late AMD after cataract surgery: hazard ratios (Confidence Interval [CI]): 0.96 (0.8,1.13; p = 0.60) for the right eye and 1.05 (0.89,1.25; p = 0.56) for the left eye. Of the matched pairs, late AMD was identified in 412 eyes that received cataract surgery and in 433 phakic controls, resulting in an odds ratio (95% CI) of 0.92 (0.77,1.10; p = 0.34). The risk of late AMD after cataract surgery from the logistic regression model was not statistically significant (risk ratio [95%CI]: 0.92 [0.56,1.49], p = 0.73). Conclusions Cataract surgery did not increase the risk of developing late AMD among the AREDS2 participants with up to 10 years of follow-up. This study provides data for counselling AMD patients who might benefit from cataract surgery.