Cataracts and age-related macular degeneration can occur in elderly patients. (Cataracts & Age-Related Macular Degeneration) Cataract surgery is likely harmless for patients with AMD, but an ophthalmologist will have to conduct a number of tests to make sure that the surgery does not cause any other vision problems. (Cataract Surgery & AMD)

While surgery will remove cataracts, there is not yet any definitive treatment for age-related macular degeneration. (Learn More)

Cataracts & Age-Related Macular Degenerationyoung woman with cataracts

What is the difference between cataracts and age-related macular degeneration? A cataract is when the lens of the eye gets clouded over by inactive proteins. They block light from reaching the retina, causing patients to experience vision that is foggy and faded.

Macular degeneration (also known as age-related macular degeneration or AMD) is the deterioration of the retina. While cataracts can be removed by surgery, macular degeneration cannot be reversed. However, some patients might be able to have some of their vision restored to them.

In most cases, the best that can be done is to slow the rate at which the patient’s vision declines. The best way to deal with macular degeneration is for patients to know if they have risk factors for the development of the disease, keep an eye on their symptoms, and maintain regular doctor visits to check on their eyes and monitor the progression of the AMD. This will help patients extend the quality of their vision for as long as possible.

As far back as 1979, the American Journal of Ophthalmology wrote that cataracts can develop in a patient who has macular degeneration (usually in older patients), and they can also be removed in that circumstance. In most cases, cataract surgery will not affect AMD. While cataracts form on the lens of the eye, macular degeneration is found in the retina, at the back of the eye.

It is possible that in the case of cataracts that have not been removed, their size might cause inflammation issues during the surgery, which might exacerbate a patient’s macular degeneration. Again, however, this is not a common occurrence.

Cataract Surgery & AMDeye with and without cataracts

Some patients might wonder if cataract surgery will improve their vision if they also have macular degeneration. There are many factors to determine whether this will happen. One of them is how cloudy the eye’s lens is.

An ophthalmologist can use a slit lamp to determine the degree of occlusion of vision, but this will only provide an estimate. The doctor should do a refraction to see whether changing glasses, or using magnifiers and other low vision aids, will improve the patient’s vision enough, before recommending surgery.

Another factor to consider how cataract surgery could interact or interfere with macular degeneration is whether the patient’s loss of vision is due to the cataract or the AMD. It might be the case that cataract surgery will not improve the patient’s vision if their retina is so damaged from advanced stages of macular degeneration. To determine whether this is the case, a retina specialist can examine the retina with a slit lamp.

There is also a potential acuity meter, or PAM, which uses a very small light beam to actually shine a vision chart directly into the eye. PAM can penetrate most cataracts, and if the patient can read the smallest letters in the chart compared to when the chart is on a wall, then an ophthalmologist might be satisfied that surgery to remove the cataract would ultimately benefit the patient’s vision.

Cataract surgery is a very safe form of surgery. Most patients will not experience any side effects or problems from having the lens of their eye replaced with an artificial lens. However, patients who have macular degeneration will likely not benefit from the multifocal plastic lens implants that are sometimes used in cataract surgery because they reduce the amount of light that can reach the retina.

 Cataract Surgery

Cataract Surgery

Cataract eye surgery is a very common and medically necessary procedure to remove and replace the eye’s natural lens when the vision has been clouded by a cataract. We offer laser-assisted cataract surgery and lifestyle lenses as options for our patients.

Learn More about Cataract Surgery

Improving Vision in AMD

The Ophthalmic and Physiological Optics journal writes that AMD patients might benefit from yellow lens implants because they block blue light. Bright lights (especially blue ones) may be a contributing factor in age-related macular degeneration. A doctor might encourage an AMD patient to wear sunglasses or tinted glasses for the same reasons.

For a patient who has both cataracts and age-related macular degeneration, cataract surgery might be performed on whichever eye is experiencing the most severe stage of AMD. This is to avoid exposing the healthier eye to any complications that might arise from cataract surgery with AMD, even if the risk is negligible. Focusing on the more affected eye also helps patients experience surgery and the improvement of their vision before the process is repeated on their healthier eye.

For a patient who has both cataracts and age-related macular degeneration, the decision to have surgery to remove the cataracts should be made by both the patient and the ophthalmologist. In most circumstances, cataract surgery will not exacerbate AMD; however, there is always some background risk of side effects and complications with any kind of surgery, and cataract surgery is no exception.

The ophthalmologist will use an array of tests to determine the degree to which cataract surgery might improve the patient’s vision. This will give the patient a realistic idea of how much their vision might improve and what the surgery might do to their macular degeneration. With this information, the patient will make the ultimate decision on whether surgery is worth the risk to try and improve their vision.

References

What Is Macular Degeneration? (August 2020). Verywell Health.

Cataracts and Macular Degeneration. (September 1979). American Journal of Ophthalmology.

Cataracts and Macular Degeneration in Older Americans. (April 1982). Archives of Ophthalmology.

Macular Degeneration and Cataract Surgery: Are They Compatible? (January 2019). American Academy of Ophthalmology.

Ask the Doctor: Will Cataract Surgery Worsen Macular Degeneration? (May 2012). Harvard University.

A Comparison of the Potential Acuity Meter (PAM) and the Illuminated Near Card (INC) in Patients Undergoing Phacoemulsification. (September 2005). Eye.

Is Cataract Surgery Justified in Patients With Age Related Macular Degeneration? A Visual Function and Quality of Life Assessment. (December 2000). British Journal of Ophthalmology.

Benefit of Coloured Lenses for Age-Related Macular Degeneration. (July 2002). Ophthalmic and Physiological Optics.

IOL Selection for Patients With Age-Related Macular Degeneration. (March 2015). CRSTEurope.

From Cataracts to Macular Degeneration: Age-Related Eye Problems and How to Treat Them. (November 2019). The Conversation.

AMD Patients Benefit From Cataract Surgery, Study. (November 2009). Medical News Today.

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