Should you have cataract surgery if you have macular degeneration?

Let’s start by providing some context about cataract surgery with macular degeneration. 

In the aging population, cataracts and Age-related Macular Degeneration (AMD) are the two main causes of visual impairment. 

When the normally clear lens becomes clouded with age, cataracts form. With cataract surgery, which includes swapping out the hazy lens for a clear artificial lens, this can be fixed. 

AMD damages the retina, and the inner rear lining of the eye, whereas cataracts impair the front portion of the eye. 

There was originally a worry that having cataract surgery may accelerate AMD. It was once believed that AMD had an inflammatory component and that the typical inflammatory response following cataract surgery may contribute to the worsening of AMD. 

However, studies comparing individuals who underwent cataract surgery to those who did not find any statistically significant difference in the course of AMD between the two groups. The eyesight of AMD patients who underwent cataract surgery, however, significantly improved. 

Patients with AMD can also be classified as having wet or dry AMD; only those with wet AMD need to be treated. Wet AMD patients require injections to stop the development of new blood vessels and decrease fluid in the retina. 

A 2015 study found that patients with wet AMD had more fluid in their retinas following cataract surgery. As a result, we often want the wet AMD to be stabilized in patients with wet AMD before the person has cataract surgery. Prior to cataract surgery, an injection may occasionally be administered to stop any possible inflammatory changes. 

The bulk of research on the matter comes to the conclusion that having cataract surgery is safe even if you have AMD, and that your vision will often improve noticeably as a result. The ophthalmologist can better track the condition of the AMD by removing the clouded lens.

How do cataracts and age-related macular degeneration (AMD) differ from one another? 

It’s crucial to first define the differences between cataracts and macular degeneration. Clouding the eye’s lens, or cataract prevents light from reaching the retina. Surgery can reverse this problem. Contrarily, macular degeneration results in the degradation of the retina’s central region and are now incurable, however, there are some situations in which vision can be improved. 

Age-Related Macular Degeneration

AMD is a retinal condition that develops when the macula is damaged. The macula, situated in the middle of the retina, enables you to distinguish finer features like faces and written text. 

Another name for this is central vision. When your central vision is impaired, it will be challenging for you to perceive minute details, whether they are nearby or far away. On the other hand, your side vision (peripheral vision) will be unaffected. 

There are two types of AMD: dry and wet. About 80% of patients who acquire AMD have dry AMD, the more prevalent of the two. Age-related macula thinning is what leads to dry AMD. Unfortunately, there is currently no effective treatment for dry AMD. 

Wet AMD is far more dangerous than dry AMD while being less frequent. Under the retina, it happens when the body begins to produce new, abnormal blood vessels that leak bodily fluids like blood. As a result, vision loss occurs considerably more quickly than it would with dry AMD, and the macula becomes scarred. 

No matter which type of AMD you have, the following variables apply to both: 

• Being 50 or more 
• Being  white E
• Elevated blood pressure 
• A high cholesterol level 
• Obesity
• A cardiac condition 
• Smoking

The majority of people discover they have AMD after their vision has declined. To identify signs before they develop into a significant issue, it’s crucial to start receiving thorough eye exams on a regular basis. 

Cataracts 

Poor eyesight is the result of cataracts, which obscure the eye’s lens. Imagine it as a windshield. Clear windshields make visibility simple. Accidents might occur because it is difficult to see through dirty windshields. Similar to how a hazy lens makes it more difficult to see. The distinction is that your eyes cannot be made clean again by running them through an eyewash. 

Cataract symptoms include: 

• Blurry vision
• Light sensitivity or glare  
• Double Vision
• Night vision issues 
• Colors that were once vibrant now appear faded. 

As people age, cataracts are often developed. Our eyes naturally change as we age, and these changes start to happen around the age of 40. This causes our eyesight to become more “cloudy” by causing the normal proteins in our eyes to break down. Cataract cloudiness normally becomes apparent at the age of 60, however, symptoms may not appear for years. 

Although age is the main factor in cataract development, there are additional factors that might affect your risk of getting the condition. These consist of: 

• Genetics  
• Other medical conditions, such as diabetes 
• Prior eye operations or traumas 
• Exposure to radiation in the upper body 
• Use of certain drugs 
• Prolonged sun exposure without using UV eye protection 

The rate at which cataracts form depends on their underlying cause, and doctors are unable to foresee when they will appear. We are aware that aging-related cataracts take a long time to develop. However, diabetics and young people may experience a quicker onset. 

You might be able to delay the onset of cataracts. Avoiding extended UV exposure to your eyes and using UV-protective eyewear are two ways to do this.

Regardless of whether or not a person has macular degeneration, cataracts can be surgically removed. People with both diseases frequently ask, “How may cataracts influence AMD and vice versa?”

If I also have AMD, would cataract surgery improve my vision? 

It is very difficult to say if cataract surgery would enhance an AMD patient’s eyesight. The lens’s cloudiness is one contributing component. The lens can be examined by an eye doctor using a slit light to see how much vision it could be obstructing. This is only an estimate, though. The eye doctor should perform a detailed refraction before suggesting cataract surgery to see whether changing glasses, using magnifiers, or using low vision aids could sufficiently enhance vision. 

Another concern is if AMD or cataracts are to blame for the reduced eyesight. Some individuals with severe AMD have retinal degeneration to the point that cataract surgery won’t if at all, enhance their eyesight. A retinal specialist can use a slit lamp to examine the retina and take unique retinal photos to determine this (including optical coherence tomography, or OCT). 

A potential acuity meter, often known as a “PAM,” is another useful diagnostic tool. This uses a small laser beam that can pass through most cataracts to show a vision chart into the eye. The cataract would probably be removed if the patient’s ability to read smaller characters with the PAM exceeds their ability to do so when reading the eye chart on the wall.

Is Surgery for Cataracts Safe? 

One of the safest surgical procedures is often cataract surgery. An ophthalmologist uses ultrasound or laser energy through a small incision in the front of the eye to carry out the procedure. The clouded lens of the patient is removed and replaced with a plastic lens. Only a small percentage of individuals experience problems after getting their lenses implanted. Serious cases of these include retinal detachment and endophthalmitis, which can both benefit from prompt treatment. 

It is now possible to get multifocal implants so that you may not need reading glasses, but macular degeneration sufferers are unlikely to benefit from them since they reduce the quantity of light that reaches the retina. There are also implants for yellow lenses that filter blue light. These could be useful for AMD sufferers since there is some proof that intense light, particularly blue light, may be one of the causes of the disease. On the other hand, tinted or sunglass eyewear can provide the same results. 

If both eyes are affected, what then? 

If a patient and ophthalmologist decide to move forward with cataract surgery, it may occasionally be carried out first on the eye with the more severe development of AMD. The better eye is initially shielded from any potential hazards of cataract surgery, no matter how slight they may seem. Additionally, it enables the patient to have cataract surgery on one eye before moving on to the more “useful” eye. 

How cataract surgery is done?

Small-incision and extracapsular cataract procedures are both available. 

During small-incision surgery, a small probe is inserted into the eye through a very small corneal incision. By sending out ultrasonic waves, the probe assists in disintegrating the affected lens, making suction extraction simpler. 

In order to remove the entire lens core in one piece during extracapsular surgery, a somewhat bigger corneal incision is needed. 

No matter the procedure, the surgeon will swap out the native lens of the eye for a plastic intraocular lens. 

Macular degeneration treatment 

Macular degeneration cannot be treated or cured by cataract surgery. The use of visual aids and glasses may be advantageous. Find out what kinds of glasses might be useful. 

Although there is no known treatment for dry macular degeneration, some research indicates that taking supplements of specific vitamins and minerals may help delay the disease’s progression. 

Anti-vascular endothelial growth factor injections are used as a kind of treatment for wet macular degeneration because they can decrease the formation of new blood vessels in the retina and prevent leaking. Some patients may benefit from laser surgery because it can help shrink blood vessels and stop fluid leaking.

Conclusion

Together, the patient and ophthalmologist must decide if the AMD patient will have cataract surgery. Although the majority of research suggests that having cataract surgery does not worsen macular degeneration, there is a small (low) chance of problems. Therefore, the ophthalmologist will try their best to estimate for the patient how much the operation could enhance vision, so that the patient can have reasonable expectations and choose if the risk of surgery is justified given the possibility of better vision.

FAQ’s

Does macular degeneration get worse after cataract surgery? 

Will Macular Degeneration Get Worse After Cataract Surgery? A few research have shown that cataract surgery may exacerbate AMD, however, the largest and most conclusive studies show no difference. 

Why hasn’t my eyesight not gotten better after my cataract surgery? 

You may have posterior capsule opacification, a common problem if you’ve had cataract surgery but your vision is still foggy or hazy (PCO). PCO, also known as a “secondary cataract,” develops when epithelial cells from the lens impede the capsule that keeps the IOL in place. 

How long after cataract surgery do you wear an eye shield at night? 

Over the first two to three days, go easy. For at least a week, wear your eye protection at night. If you require painkillers, do so. As normal, take a shower or a bath. 

Do I still require reading glasses after cataract surgery? 

The lens implanted in your eye will determine whether you need glasses following cataract surgery. For this, there are several lens choices. You can see clearly at one distance with monofocal lens implants, but you still require glasses for all other distances. 

Will my vision remain unchanged following cataract surgery? 

Expect your eyesight to start to improve a few days after cataract surgery. As your eye adapts to the injury and recovers, your vision may initially be hazy. After surgery, you may notice that colors seem brighter because you are viewing the world through a fresh, clean lens. 

What would you have liked to know prior to having cataract surgery? 

The following activities should be avoided both before and after cataract surgery to promote appropriate healing. Eat and drink nothing the night before your procedure. In order to better prevent infection, don’t wear makeup to your surgical session and hold off applying it until your ophthalmologist approves.