Visual acuity after cataract surgery in patients with age-related macular degeneration: age-related eye disease study 2 report number 5

Abstract

Objective: To evaluate visual acuity outcomes after cataract surgery in persons with varying degrees of severity of age-related macular degeneration (AMD).

Design: Cohort study.

Participants: A total of 1232 eyes of 793 participants who underwent cataract surgery during the Age-Related Eye Disease Study 2, a prospective, multicenter, randomized controlled trial of nutritional supplements for treatment of AMD.

Methods: Preoperative and postoperative characteristics of participants who underwent cataract extraction during the 5-year trial were analyzed. Both clinical data and standardized red-reflex lens and fundus photographs were obtained at baseline and annually. Photographs were graded by a centralized reading center for cortical and posterior subcapsular lens opacities and for AMD severity. Cataract surgery was documented at annual study visits or by history during the 6-month telephone calls. Analyses were conducted using multivariate repeated-measures regression.

Main outcome measures: Change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA.

Results: Adjusting for age at time of surgery, gender, interval between preoperative and postoperative visits, and type and severity of cataract, the mean changes in visual acuity were as follows: eyes with mild AMD (n = 30) gained 11.2 letters (95% confidence interval [CI], 6.9-15.5), eyes with moderate AMD (n = 346) gained 11.1 letters (95% CI, 9.1-13.2), eyes with severe AMD (n = 462) gained 8.7 letters (95% CI, 6.7-10.7), eyes with noncentral geographic atrophy (n = 70) gained 8.9 letters (95% CI, 5.8-12.1), and eyes with advanced AMD (central geographic atrophy, neovascular disease, or both; n = 324) gained 6.8 letters (95% CI, 4.9-8.8). The visual acuity gain across all AMD severity groups was statistically significant from preoperative values (P < 0.0001).

Conclusions: Mean visual acuities improved significantly after cataract surgery across varying degrees of AMD severity.

Figure 1

Preoperative (A) and postoperative (B) visual acuity of eyes analyzed. Percentages are shown for eyes with varying degrees of preoperative visual acuity and AMD severity. The visual acuity score is represented as Snellen equivalents.

Figure 2

Visual acuity scores before and after cataract surgery. Visual acuity scores and corresponding Snellen equivalents are represented in the preoperative (x-axis) and postoperative (y-axis) visits. The diagonal line intersecting the origin represents no change in visual acuity, and the values below the diagonal line represent a decrease in visual acuity.

Figure 3

Change in visual acuity after cataract surgery with varying AMD severity. Percentage of patients with gain or loss of letters on the logarithm of minimal angle of resolution of visual acuity chart is shown for eyes with mild AMD, moderate AMD, severe AMD, non-central geographic atrophy, and advanced AMD.