Do patients with age related maculopathy and cataract benefit from cataract surgery?

Abstract

Aims: To assess the benefits of cataract extraction in patients with age related maculopathy (ARM).

Methods: 1073 randomly selected cataract operations were reviewed and 99 cases of preoperatively recognised ARM were identified for investigation. Data relating to visual function were retrieved from case notes, and patient responses to a questionnaire were analysed.

Results: 98% had dry or unspecified ARM. Only 2% had exudative maculopathy. 81% of cases had an improvement in best distance acuity; mean change 0.44 logMAR (change of 6/36 to 6/12). 65% responded to the questionnaire; 67% felt that the operation had been worthwhile, 17% had mixed feelings, and 17% thought it not worthwhile.

Conclusions: This study, which is the first of its kind to be reported, shows a clear benefit from cataract surgery in the majority of patients with ARM. However, the prevalence of ARM in this study is lower than expected, suggesting that some patients with both ARM and cataract were not listed for surgery. The design of a prospective study to quantify the subjective and objective benefits of cataract surgery in these patients is outlined and predictors of successful outcome identified. This will promote the development of guidelines for the surgical management of this group of patients.

Figure 1

Frequency table showing improvement in distance visual acuity. Shading in cells approximately proportional to cell frequency. The down sloping diagonal represents no change in visual acuity, cells below and to the left represent an improvement in visual acuity. CF= counting fingers; HM= hand movements. Missing data have been omitted (n=91). Where Snellen equivalent falls between common chart test sizes the nearest poorer acuity has been used.