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Risk of Age-related Macular Degeneration 3 Years after Cataract Surgery: Paired Eye Comparisons

Jie Jin Wang, MMed, PhD,1,2 Calvin Sze-un Fong, MBBS,1 Elena Rochtchina, MApplStat,1 Sudha Cugati, MBBS, PhD,1 Tania de Loryn, MA, DipClinPsych,1 Shweta Kaushik, BMed (Hons), PhD,1 Jennifer S. L. Tan, MBBS, PhD,1 Jennifer Arnold, MBBS, FRANZCO,3 Wayne Smith, MBBS, PhD,4 Paul Mitchell, MD, PhD, FRANZCO1
Objective: To clarify possible associations between cataract surgery and progression of age-related macular degeneration (AMD). Design: Clinic-based cohort. Participants: We followed cataract surgical patients aged 65ϩ years in the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study. Patients who remained unilaterally phakic for at least 24 months after recruitment were included. Methods: We performed annual examinations with retinal photography. We assessed AMD using side-byside grading of images from all visits. Paired comparisons between operated and nonoperated fellow eyes (defined as nonoperated or operated Ͻ12 months previously) were made using generalized estimating equation models. Main Outcome Measures: Incident early AMD was defined as the new appearance of soft indistinct/ reticular drusen or coexisting retinal pigmentary abnormality and soft distinct drusen in eyes at risk of early AMD. Incident late AMD was defined as the new appearance of neovascular AMD or geographic atrophy (GA) in eyes at risk of late AMD. Results: Among 2029 recruited, eligible participants, 1851 had cataract surgery performed at Westmead Hospital, Sydney, and 1244 (70.7%) had 36-month postoperative visits. Of these participants, 1178 had gradable photographs at baseline and at least 1 follow-up visit. Of 308 unilaterally operated participants at risk of late AMD, this developed in 4 (1.3%) operated and 7 (2.3%) nonoperated fellow eyes (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.23–2.36) after adjusting for the presence of early AMD at baseline. Of 217 unilaterally operated participants at risk of early AMD, this developed in 23 (10.6%) operated and 21 (9.7%) nonoperated fellow eyes (OR, 1.07; 95% CI, 0.74 –1.65). Incident retinal pigment abnormalities were more frequent in operated than nonoperated fellow eyes (15.3% vs. 9.9%; OR, 1.64; 95% CI, 1.07–2.52). There was no difference in the 3-year incidence of large soft indistinct or reticular drusen between the 2 eyes (8.8% vs. 7.9%; OR, 1.12; 95% CI, 0.79 –1.60). Conclusions: Prospective follow-up data and paired eye comparisons of this older surgical cohort showed no increased risk of developing late AMD, early AMD, or soft/reticular drusen over 3 years. There was a 60% increased detection of retinal pigmentary changes in surgical eyes. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2012;119:2298 –2303 © 2012 by the American Academy of Ophthalmology.

Age-related cataract is a major cause of visual impairment in elderly Americans and Australians.1– 4 Cataract surgery is currently the most frequently performed ocular surgical procedure. However, a potential for cataract surgery to increase the risk of progression to late-stage age-related macular degeneration (AMD) has led to concern.5,6 Discrepancy in the currently available evidence for this risk seems divided by the nature of the study samples: Population-based studies have mostly supported an association between postcataract surgical status and late AMD over the longer term,6 –12 whereas clinicbased studies have mostly reported a negative finding of the association,13–17 although inconsistently.18

We hypothesize that the discrepancy in findings of a cataract surgery–AMD link between population- and clinicbased studies is likely due to different distributions of AMD risk factors between the 2 types of samples.19 Populationbased studies generally have used healthy older persons as controls, whereas clinic-based patient samples have used cataract surgical patients who did not develop late AMD as controls. Further, cataract surgery or the postsurgical ocular state may not in itself lead to a higher risk of AMD progression but could do so if other contributory factors are present. Compared with generally healthy, community-living older persons, clinic patients may be more likely to have
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© 2012 by the American Academy of Ophthalmology Published by Elsevier Inc.

NC) was used for data analyses. hypercholesterolemia. Study methods and procedures have been described. The mean age of this sample was 75. as described by the International AgeRelated Maculopathy classification. that developed complementary lesions. At examinations.1. with a large ophthalmic department comprising 20 consultants. agreed to participate in the CSAMD study. or the co-presence of both large soft distinct drusen and retinal pigmentary abnormalities in follow-up visits of eyes having no late or early AMD signs at baseline. Westmead Hospital. Late AMD was present in 2.4% of the sample. with overweight defined as BMI Ն25 kg/m2 and obesity defined as BMI Ն30 kg/m2.4% were of other ethnicities or mixed race.1% GA) of the study eyes. transient ischemic attack. 11.0% (0. closely following the Wisconsin Age-Related Maculopathy Grading System. using generalized estimating equation models and adjusting for the presence of preexisting early AMD lesions. retinal photographs were gradable for 1499 at the preoperative visit and for 1688 at the 1-month postoperative visit (most patients had photographs at both visits). 11. angina. Incident late AMD was defined as the presence of neovascular AMD or GA in follow-up visits of eyes having no late AMD lesions at baseline.20 Baseline retinal photographs taken before surgery or within the first postoperative month were graded for AMD lesions. informed consent to participate in the CSAMD study. and 8. For these reasons.Wang et al ⅐ AMD 3 Years after Cataract Surgery coexisting systemic and ocular pathologies.6% were Caucasian. the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study.3 (standard deviation. Australia. up to 36 months after surgery. Patients were recruited during informed consent and scheduling for cataract surgery. The study was approved by the University of Sydney and Western Sydney Area Health Service Human Research Ethics Committees and was conducted adhering to the tenets of the Declaration of Helsinki. after obtaining written. The risk of developing early or late AMD in operated compared with nonoperated fellow eyes of the same patients was assessed in those who remained unilaterally phakic for at least 24 months. Incident early AMD was similarly defined as the presence of large soft indistinct or reticular drusen. and surgical procedures. which may jointly with cataract surgery or postsurgical factors contribute to the greater observed risk of progression to late AMD. Overall. SAS Inc.23 Late AMD was defined as neovascular AMD or geographic atrophy (GA) of at least 175 ␮m diameter present within the macular area. respectively.5% of the sample.1 years. 69.22.9% neovascular AMD and 1. either before cataract surgery (76. Preoperatively.2Ϯ6.4%. Consenting participants were interviewed and examined in a standardized manner at the time of recruitment (baseline). Materials and Methods The CSAMD study is a longitudinal follow-up of patients aged 65 years of age or older who underwent cataract surgery at Westmead Hospital or private ophthalmic facilities in the Western Sydney region. Past smokers and current smokers comprised 37. The incidence of late and early AMD was assessed in both operated (the study eye) and nonoperated or only recently operated (Ͻ12 months) eyes (the control eye) of participants using side-byside grading of the retinal photographs taken at baseline and at each of the annual follow-up visits. Medical history and medications used were validated against patient records. We also analyzed data from participants who were followed for at least 36 months since cataract surgery in their study eyes to assess AMD incidence in eyes with a pseudophakic state for Ն24 months compared with nonoperated or only recently operated (Ͻ12 months) eyes (nonpaired eye comparison).3%) had retinal photographs taken and 1760 participants (86. All eligible cataract surgical patients (aged 65 years of age or older. stroke.19 The current report aimed to assess whether a link exists between postcataract surgical status and AMD progression in a clinic-based older cohort of cataract surgical patients. Results Approximately 80% of age-eligible patients undergoing cataract surgery at the Eye Clinic. Demographic data were obtained during face-to-face interviews. Of the 2029 participants.2%) and diabetes (29.1% and 14. 2029 patients aged 65 years of age or older were recruited from mid-2004 to early 2007. Westmead Hospital is the largest public hospital in Western Sydney. Odds ratios (ORs) and 95% confidence intervals (CIs) are presented.2 (standard deviation. P Ͻ 0. and systemic and ocular conditions were recorded.2% of the sample.2%). followed by hypercholesterolemia (45.20 using paired eye comparisons among patients who retained a unilateral operated state for 24 to 36 months after their first eye had cataract surgery. Cary. Supplementary analyses were performed comparing all operated eyes (regardless of the duration of operations in the eyes) with nonoperated eyes at the 36-month visits. Of the 2029 participants recruited. but not both lesions.7%) had gradable photographs from at least 1 of these 2 baseline visits. arthritis. together comprising a diagnosis of early AMD. respectively. myocardial infarct.21 modified for use in the Blue Mountains Eye Study (BMES). the average mean number of letters read correctly in the study eyes was 25. 19.20 In brief. Questions asked about medical history included history of diabetes.5) letters for presenting visual acuity and 32. were included as incident early AMD.3% (Table 1). an ideal study design to address the question about the role of cataract surgery in AMD progression is to take advantage of the 2 eyes per patient and conduct a paired comparison between surgical and nonsurgical eyes of the same patients.23 SAS (v.3%) (Table 1). height and weight were recorded. Participants were noninstitutionalized residents of the Western Sydney region. and body mass index (BMI) was calculated as weight (kilograms)/height (meters squared).0001). 1954 participants (96. or coexisting large soft distinct drusen and retinal pigmentary abnormalities. 2299 . Hypertension was the most frequent systemic comorbidity (61%). Systemic comorbidities were present in 81. Eyes with only large soft distinct drusen or retinal pigmentary abnormalities at baseline. 9. 17.2) letters for pinhole visual acuity.6%) than men (42. without late AMD in the surgical eye) were invited to participate. hypertension.0% were Asian.0% were Middle Eastern. Ocular conditions detected from photographs taken at either or both of these 2 baseline visits were considered to represent preexisting lesions before surgery (baseline). and there were more women (57. whereas overweight and obese participants comprised 35. including descriptive and analytic analyses.8%) or within the first month after surgery (23.24 Early AMD was defined as the presence of indistinct large (Ն125 ␮m diameter) soft or reticular drusen.4% and 25. The proportion of study eyes with early AMD lesions at baseline was 15. Visual acuity of each eye was assessed at each visit following the study protocol.

2300 .50)‡ 0. Of these 560 subjects (1120 eyes). not at risk of late AMD).e.3 0.3% vs. % with Comorbidity (N‫؍‬1760 surgical eyes) 60. 95% CI.64 (1. 282 already had surgery on 1 eye before being recruited into the study and 560 had no cataract surgery in either eye at the time of study recruitment. this developed in 23 (10.74–1.52) 1. Of the 842 subjects undergoing bilateral operations.6 10. Table 2. older age (per year increase.9 95% CI. % 2. % 1.66 –1. sex. or that had late AMD present at baseline (i.4 % with lesions (N‫؍‬1760 surgical eyes) 17. sex.66–1. CI ϭ confidence interval.3 9. 0. † Adjusted for early AMD lesions at baseline because the stage of early AMD lesions can be different between the 2 eyes.6 12. 1. After adjusting for age.6 8.. ‡ Adjusted for age. at Risk Incidence Paired eye comparison Late-stage AMD Early-stage AMD Soft indistinct/reticular drusen Retinal pigmentary abnormalities Nonpaired eye comparison Late-stage AMD Early-stage AMD Soft indistinct/reticular drusen Retinal pigmentary abnormalities Subjects.12.6 8.1 2.9%.07– 2.60) 1.49)‡ 0.7 10.2 29.7 7. and nonoperated eyes are defined as those that had not yet had surgery or had surgery Ͻ12 months previously by the time of the 36-month postoperative visits. 491 (982 eyes) had undergone operation Ͼ12 months previously.8 15.99 (0. Number 11. Incidence of Early.6 9.00–2.07 (0.1 7.3 2. 0.3%) operated and 7 (2. 0.36) after adjusting for the presence of early AMD at baseline. smoking.7%) nonsurgical fellow eyes (OR. and smoking.65) 1. 1178 had gradable photographs from at least 1 follow-up visit.74.6 45.2 14.3 OR Incidence in Nonoperated Eyes.65–1.and Late-Stage Age-related Macular Degeneration 3 Years after Cataract Surgery: Paired Eye and Nonpaired Eye Comparisons of Operated Eyes (Ͼ12 Months Previously) with Nonoperated or Recently Operated Eyes (Ͻ12 Months Previously).* n 1711/348 1366/282 1408/288 1400/283 Incidence in Operated Eyes. 1.3 18.94 (0. Of the 308 unilateral surgical patients at risk of late AMD. 1.99. n 308 217 227 223 Operated/nonoperated eyes. OR. 1.66 (0.3%) nonoperated fellow eyes (OR.74 (0. *Operated eyes are defined as those that had surgery Ͼ12 months previously. However.5%) had undergone bilateral cataract surgery. cataract surgery was not significantly associated with the incidence of early AMD (OR.0 15.79–1. November 2012 Table 1. 0. OR.79 –1.3 11. The incidence of retinal pigment abnormalities was more frequent in operated than in nonoperated fellow eyes (15. there were 1711 operated eyes that had surgery Ͼ12 months previously and 348 eyes that had not yet had surgery or had surgery Ͻ12 months previously for the nonpaired eye comparison.60) (Table 2). 9.14)§ AMD ϭ age-related macular degeneration.29–1.65). 0.74 –1.23–2.6%) surgical and 21 (9. § Adjusted for age.9 (95% CIs) 0.9%.07. Paired Comparison of Operated versus Nonoperated Eyes Of the 1760 participants with gradable photographs at baseline who were followed annually. 1244 (70. and all these eyes were included in this comparison as operated eyes. After excluding eyes that did not have gradable retinal photographs at both the baseline and at least 1 follow-up visit.35)§ 1. smoking. There was no difference in the incidence of large soft indistinct or reticular drusen between the 2 eyes over the 3-year period (8.4 15. Of these subjects. Nonpaired Comparison of All Operated versus Nonoperated Eyes By the time the 36-month visits were scheduled. 95% CI. this developed in 4 (1. sex.52).Ophthalmology Volume 119. 336 subjects had undergone unilateral cataract surgery and 842 subjects (71.* the Cataract Surgery and Age-related Macular Degeneration Study No. 0. There were 308 participants at risk of late AMD and 217 participants at risk of early AMD who remained unilaterally phakic for at least 24 months.23–2.7%) had 36-month postoperative visits.12 (0. and early AMD lesions at baseline.8% vs. OR ϭ odds ratio. 95% CI. 95% CI.9 12. 7. OR.36)† 1. and preexisting early AMD lesions before surgery.07–2.3 14.49) (Table 2). The remaining 69 subjects had 1 eye operated Ͼ12 months previously and the second eye operated Ͻ12 months previously by the time the 3-year follow-up visit was conducted.46 (1. There were thus 1951 (336ϩ282ϫ2ϩ982ϩ69) operated eyes and 405 (336ϩ69) eyes that had not yet had surgery or had surgery Ͻ12 months previously. Prevalence of Systemic and Ocular Comorbidities in the Cataract Surgery and Age-related Macular Degeneration Study Sample (65 Years of Age or Older) at Baseline Systemic Comorbidity Hypertension Hypercholesterolemia Diabetes Angina Myocardial infarction Stroke Any systemic comorbidities AMD lesions Any AMD Late AMD Early AMD Retinal pigmentary abnormalities Soft indistinct drusen Soft distinct drusen AMD ϭ age-related macular degeneration. Of 217 unilateral cataract surgical patients at risk of early AMD.9 9.3 10.64.9 81.

Supplementary analyses comparing all operated eyes with nonoperated eyes only at the time of 36-month visits showed the findings unaltered in both the paired eye and nonpaired eye comparisons (Table 3).24 (0.29–1.33 (0.31. there seems to be a modest increased risk of detecting or developing retinal pigmentary abnormalities in surgical eyes. Discussion We followed a large clinic cohort of older cataract surgical patients and documented no significantly increased risk of developing late or early AMD in operated compared with nonoperated eyes of the same patients 3 years after surgery.37 The higher prevalence of early AMD could partly explain the previously reported association between prior cataract surgery and subsequent risk of progression to late AMD in population-based studies because. and smoking. The Auckland Cataract Study reported that 80% of 480 cataract surgical patients had coexisting systemic medical conditions.16 Population-based longitudinal studies to document this association were able to exclude the possibility that subtle. 3. including a retrospective review conducted in the same hospital27 and several other studies of cataract surgical patients.28 an identical proportion to that found in our sample despite some age differences between the 2 studies.7 13. the proportion of cataract surgical patients with early AMD (15.65–1.47)§ 1.04) 1. and early AMD lesions at baseline. 1. CI ϭ confidence interval.48) 1. because the observed higher risk of late AMD was a longerterm risk over Ն5 years.98 (0. 3. at Risk Incidence Paired eye comparison Late-stage AMD Early-stage AMD Soft indistinct/reticular drusen Retinal pigmentary abnormalities Nonpaired eye comparison Late-stage AMD Early-stage AMD Soft indistinct/reticular drusen Retinal pigmentary abnormalities Subjects. which is substantially higher than for their age peers in the generally healthy older population.08–1.2 7.42– 6.0 6. and nonoperated eyes are defined as those that had not had surgery by the time of the 36-month visits.3 (95% CIs) 0.5 10. Whether these systemic conditions partly explain discrepancies in evidence supporting a link between cataract surgery and subsequent progression of AMD between population-based and clinic-based studies is unclear and depends on the associations of these systemic conditions with late AMD. and uncorrected visual acuity (Ͼ20/30) can usually be restored by intraocular lens implantation.68)‡ 0. 0.9 2.90. Surgical intervention is a highly effective therapy for cataract. crosssectional7.73 (0. † Unadjusted. sex.68–1.83)‡ 1. 2. 2301 .13) and the baseline presence of preexisting retinal pigmentary abnormalities (OR.6% among subjects aged 65ϩ years22).5. ‡ Adjusted for age.7 7.5 11.86–2. Although cataract surgery is arguably the most cost-effective surgical procedure worldwide. Incidence of Early. sex.04 –1. 95% CI.1 OR Incidence in Nonoperated Eyes.50).75) were predictors of incident early AMD in eyes that had surgery. in these studies.and Late-Stage Age-related Macular Degeneration 3 Years after Cataract Surgery: Paired Eye and Nonpaired Eye Comparisons of Operated and Nonoperated Eyes* by the Time of 36-Month Postoperative Visits.6 –12 In this surgical cohort.Wang et al ⅐ AMD 3 Years after Cataract Surgery Table 3.18 (0.5 A greater risk of developing late AMD after cataract surgery has been documented in some clinic25.88–2.23.17. for which evidence has been inconsistent. this link has not been consistently observed in clinic-based patient samples.9 14.3 7. OR ϭ odds ratio. 0.75–2. after adjusting for age.07 (0. sex.13–15.29 –1.66. whether it could lead to an increased risk of progression of late AMD has been a long-standing but unresolved question. unable to adjust for early AMD lesions at baseline because of small numbers. § Adjusted for age.4 8.8 9. smoking. and preexisting (baseline) early AMD lesions (Table 2).3%) was slightly higher than that reported in the BMES population (ϳ11. the Cataract Surgery and Age-related Macular Degeneration Study No.08.27) or soft distinct drusen (OR.33)† 1.26 and in most population-based.87) 1.* n 1769/284 1411/234 1453/240 1448/230 Incidence in Operated Eyes. choroidal neovascularization was present before surgery. 1.30 (0. The presence of early AMD lesions is the strongest risk factor for progression to late AMD. we observed that more than 80% of patients reported systemic comorbidities. % 0. However. 95% CI. % 2.28 –32 all of which documented that coexisting medical conditions are frequent among patients undergoing cataract surgery. n 252 175 183 183 Operated/nonoperated eyes.6 9.8 and longitudinal studies.18 including the Age-Related Eye Disease Study sample. smoking. 95% CI.7 10.75–1. The latter finding may have been the result of detection bias due to difficulty in detecting subtle retinal pigmentary abnormalities in cataractous eyes relative to that in aphakic or pseudophakic eyes.14)§ AMD ϭ age-related macular degeneration. 2.30 – 4. Cataract surgery also was not significantly associated with incident late AMD (OR. These findings are consistent with many previous studies. *Operated eyes are defined as those that had surgery. 95% CI.9 –12 However. unrecognized.7 0.33–36 Of note.47 (0.

Our study findings may provide a partial explanation for the inconsistent observations on the potential links between cataract surgery and AMD from population. We took advantage of the 2 eyes per patient19 to conduct paired comparison between surgical and nonsurgical eyes of the same patients. Annu Rev Public Health 1996. Javitt JC. A limitation of the study is the self-reported nature of most of the ocular and systemic conditions. 1. West SK. Rahmani B. and AMD-risk genes are exactly matched. Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis.120:1551– 8. 9.53:359 – 67. Klein R. Bockelbrink A. smoking. Mitchell P. 5. Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study.8-fold (95% CI. include photographic documentation of the macula before or shortly after surgery and annually after surgery for up to 3 years.38 Of particular interest. where all other covariables such as age. The association of cataract and cataract surgery with the long-term incidence of age-related maculopathy: the Beaver Dam Eye Study.19 The strengths of this study. References 1. the presence of cataract at baseline predicted a slight increase in the 10-year incidence of early AMD. baseline cataract also predicted 14-year incident early or late AMD (OR. Cugati S. Klein R. in addition to the paired eye comparison of the same patients enabling the exact match for systemic AMD risk profile between the 2 comparison groups (operated and nonoperated eyes). In a patient-to-patient comparison (which is the case in clinic-based studies).2).135:849 –56. Invest Ophthalmol Vis Sci 2005.17: 159 –77. Am J Ophthalmol 2003. Krishnaiah S. Wang Q. paired eye comparison of this older surgical cohort showed a 50% higher risk of detecting or developing retinal pigment changes in surgical eyes over 3 years. Ophthalmology 2003. et al. 8. Klaver CC. 10. Chakravarthy U. we documented that only age and preexisting early AMD lesions were associated with incident late AMD in this surgical cohort. 7. The Baltimore Eye Survey.biomedcentral.110:1960 –7.3– 6. 3.9 In pooled BMES and BDES data. Das T. et al.10 In the Copenhagen City Eye Study. Smith W. our findings seem to indirectly support the speculation that the risk of AMD is higher among surgical patients than among generally healthy older persons (who were the controls in population-based studies).36:182–91. Blindness due to cataract: epidemiology and prevention. Arch Ophthalmol 1998. Wong TY. Number 11. and glaucoma to visual acuity.8. Cataract surgery and the development or progression of age-related macular degeneration: a systematic review. Wolfs RC. Klein R.103:1721– 6. Wang JJ. However.and clinic-based studies. Freeman EE. 1. In conclusion. 2302 . et al. Tielsch JM.1) greater 5-year risk of GA. other ocular pathologies associated with cataract surgery could also increase the risk of progression to late AMD. Ophthalmology 2006. Available at: http://www. In the nonpaired eye comparison analysis. Accessed July 4. Katz J. we were limited to a small number of unilateral surgery patients who were eligible for paired eye comparison. The different distributions of comorbidities between clinic-based and population-based samples highlight the importance of study sample and control group selection to the research question under investigation and to the appropriate interpretation of study findings.Ophthalmology Volume 119. 95% CI. Given that the previously documented positive association between cataract surgery and AMD was over a period of Ն5 years.12 all adjusted for preexisting early AMD lesions or its stage of AMD in their statistical models. et al.com/ 1471–2415/10/31. Invest Ophthalmol Vis Sci 1995.12 Although longer-term follow-up (at least 5 years) is needed to further clarify this important question. et al. et al. In the BDES. 11. 4. November 2012 cataract surgical patients were compared with generally healthy older individuals. Previous reports from pooled 5-year incidence data of BMES and Beaver Dam Eye Study (BDES) samples.10:31.2– 6. et al. Vingerling JR. Klein BE. the Rotterdam Study documented that only carriers of the CFH-Y402H risk allele had a significantly increased risk of developing GA after cataract surgery or in association with the pseudophakic state. Future studies are needed to assess whether cataract surgery or postsurgical ocular status jointly with other AMD risk factors contributes to a greater risk of late AMD in cataract surgical patients. Wang F. 2. Nirmalan PK. Surv Ophthalmol 2008. et al.10 and from the 10-year BMES follow-up11 and the 10-year Rotterdam Study followup. Cataract surgery and the 10-year incidence of age-related maculopathy: the Blue Mountains Eye Study. et al. Fletcher A. Munoz B. Ruether K. West SK.46:4442–9.116:653– 8. a difference may be evident when patients are compared with generally healthy older persons living in the community (which is the case in population-based studies). Apart from early AMD lesions. 2. We found no significantly increased risk of the development of late or early AMD in operated versus nonoperated eyes of the same patients over 3 years.113: 2020 –5. et al. The cause-specific prevalence of visual impairment in an urban population. There may be differences between patient samples and population-based controls but not between surgical and nonsurgical states. Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains Eye Studies. Risk factors for age-related macular degeneration: findings from the Andhra Pradesh Eye Disease Study in south India. 6. We also documented that the distribution of early AMD lesions was more frequent among patients undergoing cataract surgery than among their age peers in the older population. Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies. even though validation was undertaken from clinic notes. a difference may not be detected. cataract. Klein BE. but no increased risk of developing late or early AMD or soft/reticular drusen. to maximize sample size we included patients who had the second eye operated less than 1 year previously in paired comparison analysis. The relationship of agerelated maculopathy. Arch Ophthalmol 2002. 2012. BMC Ophthalmol [serial online] 2010. Ophthalmology 1996. regardless of cataract surgery status. Wong TY. we reported that baseline cortical cataract predicted a 2. Roll S. 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