Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation

Risk of advanced age-related macular degeneration after cataract surgery in the Age-Related Eye Disease Study: AREDS report 25

PURPOSE

To assess the risk of advanced age-related macular degeneration (AMD) developing after cataract surgery.

DESIGN

Cohort study.

PARTICIPANTS

Four thousand five hundred seventy-seven participants (8050 eyes) from a multicenter, controlled, randomized clinical trial, the Age-Related Eye Disease Study (AREDS).

METHODS

Development of advanced AMD, either neovascular (NV) AMD or geographic atrophy (GA), was evaluated with annual fundus photographs, and history of cataract surgery was assessed every 6 months. Cox proportional hazard models with time-dependent covariates were conducted for NV AMD and GA separately.

MAIN OUTCOME MEASURES

Neovascular AMD, GA, and central GA (CGA; involving the center of the macula).

RESULTS

The Cox proportional hazards model of right eyes showed nonsignificant hazard ratios of 1.20 (95% confidence interval [CI], 0.82-1.75) for NV AMD, 0.80 (95% CI, 0.61-1.06) for GA, and 0.87 (95% CI, 0.64-1.18) for CGA. Similar results were obtained for left eyes: 1.07 (95% CI, 0.72-1.58) for NV AMD, 0.94 (95% CI, 0.71-1.25) for GA, and 0.86 (95% CI, 0.63-1.19) for CGA. For participants with advanced AMD in 1 eye (AREDS category 4), the hazard ratios for fellow eyes were 1.08 (95% CI, 0.65-1.72) for NV AMD and 0.98 (95% CI, 0.64-1.49) for CGA.

CONCLUSIONS

The AREDS results showed no clear effect of cataract surgery on the risk of progression to advanced AMD.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Surgery for cataracts in people with age-related macular degeneration

BACKGROUND

Cataract and age-related macular degeneration (AMD) are significant causes of decreased vision in the elderly that often occur simultaneously. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of progression of underlying AMD and thus have deleterious effects on vision.

OBJECTIVES

The objective of this review was to evaluate the effectiveness and safety of cataract surgery in eyes with AMD.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2008), MEDLINE (January 1966 to November 2008), EMBASE (January 1980 to November 2008) and Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to November 2008). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 4 November 2008.

SELECTION CRITERIA

We planned to include randomized controlled trials (RCTs) and quasi-randomized trials of eyes affected by both cataract and AMD in which cataract surgery would be compared to no surgery.

DATA COLLECTION AND ANALYSIS

Two authors independently evaluated the search results against the inclusion and exclusion criteria. Discrepancies were resolved by discussion.

MAIN RESULTS

We found no RCTs, thus no analysis was conducted. Evidence was limited to non-randomized clinical trials and prospective cohort and case-control studies.

AUTHORS' CONCLUSIONS

At this time, it is not possible to draw reliable conclusions from the available data to determine whether cataract surgery is beneficial or harmful in people with AMD. Physicians will have to make practice decisions based on best clinical judgement until controlled trials are conducted and their findings published.

Mechanism of the efficient tryptophan fluorescence quenching in human gammaD-crystallin studied by time-resolved fluorescence

Human γD-crystallin (HγD-Crys) is a two-domain, β-sheet eye lens protein found in the lens nucleus. Its long-term solubility and stability are important to maintain lens transparency throughout life. HγD-Crys has four highly conserved buried tryptophans (Trps), with two in each of the homologous β-sheet domains. In situ, these Trps will be absorbing ambient UV radiation that reaches the lens. The dispersal of the excited-state energy to avoid covalent damage is likely to be physiologically relevant for the lens crystallins. Trp fluorescence is efficiently quenched in native HγD-Crys. Previous steady-state fluorescence measurements provide strong evidence for energy transfer from Trp42 to Trp68 in the N-terminal domain and from Trp130 to Trp156 in the C-terminal domain [Chen, J., et al. (2006) Biochemistry 45, 11552−11563]. Hybrid quantum mechanical−molecular mechanical (QM-MM) simulations indicated that the fluorescence of Trp68 and Trp156 is quenched by fast electron transfer to the amide backbone. Here we report additional information obtained using time-resolved fluorescence spectroscopy. In the single-Trp-containing proteins (Trp42-only, Trp68-only, Trp130-only, and Trp156-only), the highly quenched Trp68 and Trp156 have very short lifetimes, τ ∼0.1 ns, whereas the moderately fluorescent Trp42 and Trp130 have longer lifetimes, τ ∼3 ns. In the presence of the energy acceptor (Trp68 or Trp156), the lifetime of the energy donor (Trp42 or Trp130) decreased from ∼3 to ∼1 ns. The intradomain energy transfer efficiency is 56% in the N-terminal domain and is 71% in the C-terminal domain. The experimental values of energy transfer efficiency are in good agreement with those calculated theoretically. The absence of a time-dependent red shift in the time-resolved emission spectra of Trp130 proves that its local environment is very rigid. Time-resolved fluorescence anisotropy measurements with the single-Trp-containing proteins, Trp42-only and Trp130-only, indicate that the protein rotates as a rigid body and no segmental motion is detected. A combination of energy transfer with electron transfer results in short excited-state lifetimes of all Trps, which, together with the high rigidity of the protein matrix around Trps, could protect HγD-Crys from excited-state reactions causing permanent covalent damage.

Transmittance characteristics of ultraviolet and blue-light-filtering intraocular lenses

PURPOSE

To record the spectral transmittance curves of various ultraviolet (UV) and blue-light-filtering intraocular lenses (IOLs), evaluate their UV and blue-light-radiation- absorption capacities, and compare them with those of the natural crystalline lens.

SETTING

Department of Ophthalmology, Duisburg-Essen University, Essen, Germany.

METHODS

Eight IOLs from 6 manufacturers were evaluated. The transmittance of wavelengths from 200 nm to 800 nm was measured using a high-performance spectrophotometer with a diffuse transmittance accessory through a 1.5 mm aperture.

RESULTS

All assessed IOLs provided good UVC (200 to 280 nm) and UVB (280 to 320 nm) protection, but 2 IOLs lacked sufficient UVA (320 to 400 nm) protection. Major differences in the absorption capacities were observed in the blue-light range (400 to 500 nm).

CONCLUSIONS

The absorption characteristics of some UV and blue-light-filtering IOLs resembled those of the crystalline lens, but some differed. Long-term clinical trials should be performed to determine how blue-blocking IOLs affect the risk for progression of age-related macular degeneration.

AcrySof Natural filter decreases blue light-induced apoptosis in human retinal pigment epithelium

PURPOSE

The effect of AcrySof filter (UV light-filtering chromophore; Alcon) and AcrySof Natural filter (UV- and blue light-filtering chromophores) on blue light-induced apoptosis in human retinal pigment epithelial (RPE) cells was evaluated.

DESIGN

Laboratory investigation

CLINICAL RELEVANCE

Acrysof Natural filter reduces the blue-light toxicity in RPE cells and may have a positive impact on age-related macular degeneration (AMD).

METHODS

RPE cells were exposed to blue light (430-450 nm) in the presence of either the AcrySof (UV only) filter or Acrysof Natural (UV and blue light) filter for 10 days. The rate of apoptosis was analyzed.

RESULTS

Blue light induced significant apoptosis in RPE cells. AcrySof Natural filter significantly reduced the blue light-induced apoptosis when compared to AcrySof filter. The amount of blue-light energy reaching the cells with the AcrySof filter was 4.25 mW/cm(2) and with the AcrySof Natural filter was 2.5 mW/cm(2).

CONCLUSIONS

AcrySof Natural filter significantly reduced blue light-induced apoptosis. This was most likely due to its filtering effect on blue wavelength light, which reduces the energy that reaches the cells. In patients with cataract who are at a high risk for AMD, the implantation of a blue light-filtering intraocular lens may be considered.

Impact of Cataract Surgery on Quality of Life in Patients with Early Age-Related Macular Degeneration

PURPOSE

To investigate if cataract surgery improves overall and specific areas of quality of life (QoL) in patients with early age-related macular degeneration (AMD) using the impact of vision impairment (IVI) questionnaire.

METHODS

Patients with visually significant cataract and early AMD, who were being considered for cataract surgery in the study eye, were recruited. Eligible patients were randomized to either "early surgery" or "standard surgery" (standard cataract surgery waiting time of 6 months) groups. The IVI, sociodemographic, and clinical data were collected. Rasch analysis was used to estimate QoL person measures at baseline and follow-up. The data were analyzed using repeated measures ANOVA. Effect sizes were calculated using Cohen's d coefficient.

RESULTS

Fifty six patients (mean age = 78.5 years and visual acuity = 6/15) had one eye randomly allocated to either the early surgery (n = 29) or standard surgery (n = 27) groups. At follow-up, significant interaction effects were found for the overall IVI score [F(1,54) = 17.7; p < 0.001], the emotional well-being [F(1,54) = 13.4; p = 0.001], mobility and independence [F(1,54) = 13.4; p = 0.001], and reading and accessing information subscales [F(1,54) = 13.1; p = 0.001]. The standard surgery group systematically recorded worse scores at 6 months on all QoL measures whereas the early surgery group recorded significant gains (p < 0.001; Cohen's d = 0.66 to 0.91) on all of them. Visual acuity in the study eye significantly improved in the early surgery group only (Cohen's d = 1.1; p < 0.05) and improvement in log MAR lines read was identified as the single independent predictor of enhanced QoL explaining between 26 and 34% of the variance in the IVI scores.

CONCLUSIONS

Cataract surgery is justified in patients with early AMD. It brings significant improvements in visual acuity, aspects of daily living, and overall QoL.

Scotopic sensitivity and color vision with a blue-light-absorbing intraocular lens

PURPOSE

To investigate possible adverse effects of a yellow-tinted intraocular lens (IOL) on scotopic sensitivity and hue discrimination.

SETTING

Departments of Ophthalmology, Columbia University and New York University School of Medicine, New York, New York, USA.

METHODS

Nine patients with a yellow-tinted IOL in 1 eye and a colorless ultraviolet IOL in the fellow eye and 9 young phakic subjects with and without a yellow-tinted clip-on lens were tested. Hue discrimination was measured with the Farnsworth-Munsell (FM) 100-hue test. Dark-adapted thresholds to 440 nm, 500 nm, and 650 nm lights were measured at 23 locations using a modified Humphrey perimeter, and dark-adapted thresholds to white light were measured at 15 degrees temporal retina.

RESULTS

In the 9 patients, there were no significant differences in dark-adapted sensitivities to 440, 500, 650 nm, or white-light stimuli and no differences in FM 100-hue error scores between eyes with yellow-tinted IOLs and those with colorless IOLs. Similarly, in young phakic subjects, there were no significant differences in FM 100-hue error scores or dark-adapted sensitivity to the white light with and without the yellow-tinted clip-on lens. However, with the clip-on lens, mean sensitivities to the 440 nm, 500 nm, and 650 nm stimuli were significantly decreased by 2.7 to 2.8 dB, 0.7 to 1.0 dB, and 0 to 1.2 dB, respectively.

CONCLUSION

Results suggest that implantation of a yellow-tinted IOL has non-significant effect on scotopic sensitivity and hue discrimination.

Cataract Surgery Is Associated with a Higher Rate of Photodynamic Therapy for Age-Related Macular Degeneration

PURPOSE

To investigate the association between cataract surgery and the rate of photodynamic therapy (PDT) for age-related macular degeneration (AMD).

DESIGN

Observational population-based retrospective case-control study.

PARTICIPANTS

All members in a district of the largest health maintenance organization (HMO) in Israel > 50 years old on January 1, 2001, who did not terminate their membership through May 31, 2005 (139 894 members).

METHODS

All PDT procedures for AMD performed in the study population between January 1, 2001 and May 31, 2005 (283 patients) and all cataract surgeries performed between January 1, 2001 and December 31, 2003 (5913 patients) were documented. We extracted clinical information from the chronic disease registry of the HMO as well as demographic and socioeconomic information. For each patient that underwent cataract surgery, 5 HMO members matched in age, gender, chronic diseases (systemic hypertension, diabetes, hyperlipemia, and ischemic heart disease), place of residence, country of birth and socioeconomic status, who did not undergo cataract surgery, were randomly chosen as controls (n = 29 565).

MAIN OUTCOME MEASURES

The rate for undergoing PDT at different time periods after cataract surgery.

RESULTS

Fifty (0.85%) cataract patients and 94 control cases (0.32%) underwent PDT after cataract surgery (P<0.0001, chi-square test). A significant rise in PDT rate was noticed in cataract patients compared to controls during the first 6 months after surgery (P = 0.004, chi-square test). Between 6 and 12 months postoperatively, the PDT rates were similar in both groups. However, a more significant rise in PDT rates occurred between 1 and 1.5 years after surgery (P<0.0001, chi-square test). The Kaplan-Meier PDT-free survival curve of cataract patients was significantly worse than that of the controls (P<0.0001, chi-square test; P = 33.7, log-rank test). The hazard ratio for cataract patients compared to controls to undergo PDT after surgery was 2.7 (confidence interval = 2.4-5.7). The most significant factors to reduce the time to PDT were advanced age followed by having had cataract surgery, place of birth, socioeconomic status, and hyperlipidemia (Cox proportional hazards survival regression).

CONCLUSIONS

We identified an increased rate of PDT, presumably for subfoveal AMD, 1 to 1.5 years after cataract surgery.

Choroidal neovascularization in highly myopic eyes after cataract surgery

PURPOSE

To determine the incidence and characteristics of choroidal neovascularization (CNV) in patients with high myopia (>or=8 diopters) who underwent cataract surgery in the Department of Ophthalmology, Tokyo Medical and Dental University, or the Ohno Eye Clinic, Tokyo, between September 1991 and March 2000.

METHODS

The medical records of 35 patients (48 eyes) who underwent cataract surgery with phacoemulsification and intraocular lens implantation were studied retrospectively. The development of CNV over a 4-year follow-up period, and its characteristics were determined. All of the eyes had received a comprehensive ophthalmological examination, including best-corrected visual acuity measurements, anterior segment biomicroscopy, and a dilated fundus examination by stereoscopic observation.

RESULTS

CNV was found in six eyes (12.5%) of six patients. The mean interval between cataract surgery and the development of CNV was 34+/-17 months (range, 12-48 months). The CNV was subfoveal in all cases. The mean logarithm of the minimum angle of resolution (logMAR) after cataract surgery and before the appearance of CNV was 0.23+/-0.24, and 0.93+/-0.41 after the CNV appeared. This decrease was statistically significant (P=0.0008, paired Student t test). Subfoveal CNV developed more frequently in eyes when the fellow eye showed evidence of CNV preoperatively (40.0%) than in eyes when the fellow eye exhibited no evidence of CNV (9.3%).

CONCLUSIONS

CNV developed in 12.5% of patients with high myopia after cataract surgery. CNV tended to develop more frequently when the fellow eye had CNV.

AcrySof Natural intraocular lens optical characteristics during and after different doses of ultraviolet-visible light illumination

PURPOSE

To determine the optical transmission properties of a recently introduced intraocular lens (IOL) (AcrySof Natural SN60AT, Alcon Laboratories) and compare them with those of a conventional IOL (AcrySof SA60AT, Alcon Laboratories) after ultraviolet (UV)-visible light irradiation.

SETTING

Eye Clinic and Department of Clinical Physiopathology, University of Florence, and the National Institute of Applied Optics, Florence, Italy.

METHODS

Two IOLs, the AcrySof Natural with a UV and blue-light filter and the AcrySof without a blue-light filter, were studied. Three IOLs of each model with different dioptric powers were examined in two experimental setups. The samples were stressed with very high irradiance to reproduce light aging, and the transmission properties of the IOLs were studied.

RESULTS

No significant decrease in transmission was found at a UV-visible light dose equivalent to 100 years of light aging.

CONCLUSION

The AcrySof Natural IOL has stable optical characteristics.

Macular Choroidal Neovascularization in Myopic Eyes After Phakic Intraocular Lens Implantation

PURPOSE

To analyze the development and characteristics of choroidal neovascularization in highly myopic patients corrected by the implantation of phakic intraocular lenses (PIOLs).

METHODS

This retrospective, noncomparative interventional case series studied the development of choroidal neovascularization in 522 consecutive highly myopic eyes (spherical equivalent refraction >-6.00 diopters [D] and/or axial length >26 mm) (323 patients) corrected by the implantation of PIOLs, the treatment performed, and the results obtained. Parameters evaluated were best spectacle-corrected visual acuity (BSCVA) before and after treatment of choroidal neovascularization, and the interval between refractive surgery and the development of choroidal neovascularization.

RESULTS

Follow-up ranged from 12 to 145 months (mean: 60.4 +/- 39.1 months). In 12 (2.29%) eyes, choroidal neovascularization developed after PIOL implantation at a mean interval time of 33.7 +/- 29.6 months (range: 1 to 87 months). Using Kaplan-Meier analysis, the risk of choroidal neovascularization in patients with high myopia corrected by PIOL implantation was 0.57% at 5 months, 0.81% at 18 months, 1.31% at 24 months, and 3.72% at 87 to 145 months. No statistically significant differences were found between patients with and without choroidal neovascularization in the following parameters: axial length (P=.826), age (P=.296), initial BSCVA (P=.085), spherical equivalent refraction (P=.663), and follow-up (P=.955).

CONCLUSIONS

Phakic intraocular lens implantation for the correction of high myopia does not play a role in the development of choroidal neovascularization.

Cataract surgery and the 10-year incidence of age-related maculopathy: the Blue Mountains Eye Study

PURPOSE

To assess the long-term (10-year) risk of late age-related maculopathy (ARM) in eyes that had previously undergone cataract surgery (before the baseline examination).

DESIGN

Population-based cohort study.

PARTICIPANTS

In the Blue Mountains Eye Study (BMES) cohort, 2335 of 3654 baseline participants > or =49 years old (75% of survivors) were reexamined after 5 years and 1952 (76% of survivors) were reexamined after 10 years.

METHODS

At the baseline examination, nonphakic (aphakic or pseudophakic) eyes were identified at slit-lamp examination and confirmed at lens photographic grading. Side-by-side grading of baseline and follow-up stereoretinal photographs was performed using the Wisconsin ARM grading system. Eye-specific data were analyzed using Kaplan-Meier estimates and generalized estimating equation models, adjusting for correlation between the 2 eyes.

MAIN OUTCOME MEASURES

Incident late ARM was defined if either neovascular ARM or geographic atrophy developed in eyes without either lesion at baseline.

RESULTS

After excluding eyes with either late ARM lesion at baseline or that had missing photographs at either examination, 4763 eyes were considered at risk of incident late ARM, including 132 eyes that had cataract surgery before the baseline examination. Late ARM developed in 10 of 132 nonphakic eyes (7.6%) compared to 96 of 4631 phakic eyes (2.1%). After adjusting for baseline age, gender, smoking, and presence of early ARM lesions, nonphakic (cataract surgical) eyes had a 3-fold risk of developing late-stage ARM (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.1-9.9) or neovascular ARM (OR, 3.4; 95% CI, 1.1-10.9) compared to phakic eyes.

CONCLUSIONS

Our findings support the hypothesis that the long-term risk of developing late ARM is higher in cataract surgical eyes, consistent with findings from the Beaver Dam Eye Study.

Capabilities of potential vision test measurements

PURPOSE

To determine the usefulness of a battery of potential vision tests (PVTs) including potential acuity meter (PAM), laser interferometer (LI), critical flicker/fusion frequency (CFF), superilluminated pinhole at distance (SPH(d)) and near (SPH(n)), and optimal reading speed (ORS) by their independence of the effects of cataracts and sensitivity to macular disease (MD).

SETTING

Department of Optometry, University of Bradford, Bradford and Leeds General Infirmary, Leeds, United Kingdom.

METHODS

Potential vision test measurements were determined in 76 patients with age-related cataract and no other eye disease, 52 patients with MD and clear ocular media, and 28 patients with normal, healthy eyes.

RESULTS

Potential vision tests were independent of the degrading effects of cataract up to a visual acuity (VA) level of 20/200 or worse (CFF), 20/125 (ORS and SPH), and 20/40 (PAM and LI). A high degree of association was found between PVT scores and distance VA in the MD group for SPH(d) (r2 = 0.93), SPH(n) (r2 = 0.89), and PAM (r2 = 0.71). A moderate correlation was found for LI (r2 = 0.55), CFF (r2 = 0.50), and ORS (r2 = 0.45).

CONCLUSIONS

Potential acuity meter and LI showed very limited independence to moderate/dense cataracts and inaccurate predictions in patients with MD. Superilluminated pinhole was relatively unaffected by moderate/dense cataract and yet provided accurate predictions in the presence of MD and clear ocular media. Critical flicker/fusion frequency showed the greatest ability to bypass cataracts, although its ability to predict VA in patients with early MD was limited. The ORS was relatively unaffected by moderate/dense cataract, but its poor ability to predict VA in MD may limit its clinical suitability as a PVT.

Visual function in patients with yellow tinted intraocular lenses compared with vision in patients with non-tinted intraocular lenses

AIM

To compare the visual function in patients with short wavelength blue light blocking yellow tinted intraocular lenses (IOLs) with that in patients with non-tinted IOLs.

METHODS

74 patients scheduled for bilateral cataract surgery underwent implantation of either yellow IOLs (HOYA YA60BB) or non-tinted IOLs (VA60BB) in both eyes. Contrast visual acuity with and without a glare source was measured under photopic (100 cd/m2) and mesopic (slightly higher luminance than typically used-5 cd/m2) conditions at 2 weeks and 3 months after surgery using the contrast sensitivity accurate tester. Visual acuity and the incidence of patients who noted cyanopsia were also examined.

RESULTS

No significant differences between the yellow tinted and non-tinted IOL groups were observed in mean visual acuity or in photopic or higher luminance mesopic contrast visual acuity with and without glare source at either 2 weeks or 3 months after surgery. Furthermore, there was no significant difference in contrast visual acuity loss as a result of glare. The incidence of patients who noticed cyanopsia was significantly less in the yellow tinted IOL group than in the non-tinted IOL group at 2 weeks after surgery (p = 0.0234), but no patients reported cyanopsia at 3 months.

CONCLUSION

Visual function in patients with yellow tinted IOLs is virtually the same as that in patients with non-tinted IOLs.

Age-related maculopathy and the impact of blue light hazard

The pathogenesis of age-related maculopathy (ARM), the most common cause of visual loss after the age of 60 years, is indeed a complicated scenario that involves a variety of hereditary and environmental factors. The pathological cellular and molecular events underlying retinal photochemical light damage, including photoreceptor apoptosis, have been analysed in experimental animal models. Studies of age-related alterations of the retina and photoreceptors, the accumulation of lipofuscin in retinal pigment epithelium (RPE) cells, and the formation of drusen have greatly contributed to our knowledge. A new concept of an inflammatory response to drusen has emerged, suggesting immunogenic and systemic reactions in Bruch's membrane and the subretinal space. Oxidative stress and free radical damage also impact on the photoreceptors and RPE cells in the ageing eye. Based on the photoelectric effect, a fundamental concept in quantum physics, the consequences of high-energy irradiation have been analysed in animal models and cell culture. Short-wavelength radiation (rhodopsin spectrum), and the blue light hazard (excitation peak 440 nm), have been shown to have a major impact on photoreceptor and RPE function, inducing photochemical damage and apoptotic cell death. Following cataract surgery, there is a dramatic change in ocular transmittance. In aphakic or pseudophakic eyes (with clear intraocular lenses), high-energy (blue) and ultraviolet-A radiation strikes the retina. Epidemiological data indicate a significantly increased 5-year incidence of late ARM in non-phakic eyes compared with phakic eyes. In recent years, putative prophylactic measures against ARM have emerged. The implantation of 'yellow' intraocular lenses (IOLs) that absorb high-energy blue radiation is, from a theoretical point of view, the most rational approach, and, from a practical point of view, is easy to accomplish. With increasing age, RPE cells accumulate lipofuscin (chromophore A2E). It is noteworthy that the yellow IOL not only protects A2E-laden human RPE cells from blue light (peak 430 nm) damage, but also alleviates the detrimental effects of green (peak 550 nm) and white light. A prophylactic treatment using antioxidants is aimed at counteracting oxidative stress and free radical cellular damage. The Age-Related Eye Disease Study (AREDS), a randomized clinical trial, showed a significantly lower incidence of late ARM in a cohort of patients with drusen maculopathy treated with high doses of antioxidants than in a placebo group. In recent years, considerable progress in retinal research has been achieved, creating a platform for the search for new prophylactic and therapeutic measures to alleviate or prevent photoreceptor and RPE degeneration in ARM.

Discriminative power of reading tests to differentiate visual impairment caused by cataract and age-related macular degeneration

PURPOSE

To determine whether preoperative reading tests can be used for differentiating visual impairments with regard to the diagnosis of cataract and age-related macular degeneration (ARMD).

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

METHODS

Reading performance of patients with nuclear cataract, posterior subcapsular cataract, and ARMD were evaluated with respect to reading acuity, maximum reading speed, and critical print size; normal-sighted participants were tested as controls. A multivariate discriminant analysis of the 4 groups (100 eyes of 100 participants) was performed to evaluate how many patients could be correctly diagnosed by significant differences in the tested reading parameters. Subsequently, the nuclear cataract and posterior subcapsular cataract patients were compared with cataract patients with coexisting ARMD.

RESULTS

Distance visual acuity was comparable in the nuclear cataract, posterior subcapsular cataract, and ARMD groups (P>.05). Reading acuity was significantly reduced in posterior subcapsular cataract and ARMD patients compared with nuclear cataract patients and controls (P<.0001). No significant difference in maximum reading speed was found between the nuclear cataract patients and the controls (P = .07), whereas the maximum reading speed of the posterior subcapsular cataract and ARMD patients was significantly reduced (P<.0001). In the discriminant analysis, it was possible to assign the correct diagnosis to 72% of the nuclear cataract patients, 76% of the posterior subcapsular cataract patients, 72% of the ARMD patients, and 92% of the controls. Comparing the reading performance of nuclear cataract and posterior subcapsular cataract patients and cataract patients with coexisting ARMD showed that reading performance was significantly impaired in the comorbid patients (nuclear cataract and ARMD, P<.001; posterior subcapsular cataract and ARMD, P<.05).

CONCLUSION

The high discriminant accuracy shows that this standardized reading test system is a valuable diagnostic tool for evaluating functional visual impairments when distance visual acuity alone cannot elucidate the origin of functional impairment. Considering the significant discrepancies in reading performance among patients with nuclear cataract, posterior subcapsular cataract, and ARMD, reading tests may relevantly improve the clinical evaluation of patients with visual loss, even of patients with ocular comorbidity.

Early age-related maculopathy in eyes after cataract surgery

PURPOSE

To assess age-related maculopathy (ARM) in eyes of patients who had undergone cataract surgery for at least a year.

METHODS

Consecutive patients aged 60+ years who had undergone cataract surgery at Westmead Hospital, Sydney, Australia, during 2001-2003 were examined in 2004. Interview using standardized questionnaires and stereo retinal photography was performed. Retinal photographs were graded using the Wisconsin ARM grading system. The proportions with ARM were compared between surgical and nonsurgical eyes, and between this surgical cohort and the Blue Mountains Eye Study (BMES) population.

RESULTS

Of the 622 eligible patients, 454 (73%) were re-examined, with a mean follow-period of 2.8 years. Surgical eyes had a higher proportion of early ARM compared to nonsurgical eyes (15.2 vs10.3%, P=0.07) and to the early ARM prevalence found in BMES participants of similar age (14.5 vs6.9%, P<0.01), which persisted after age standardization to the BMES population (9.7 vs6.9%, P<0.05).

CONCLUSIONS

We found an increased prevalence of early ARM in surgical eyes of patients 1-3 years after cataract surgery. Whether this increased early ARM prevalence leads to an increased prevalence of late ARM in the long-term warrants further investigation.

Cataract surgery in patients with age-related maculopathy: preoperative diagnosis and postoperative visual acuity

PURPOSE

To report the reliability in detecting age-related maculopathy (ARM) lesions before cataract surgery and postoperative visual acuity (VA) in cataract surgery patients with ARM.

METHODS

Medical records of surgical patients in a large public hospital, west of Sydney, were reviewed retrospectively. Detection of ARM lesions was compared before and after surgery to determine sensitivity and specificity of preoperative diagnoses. Postoperative VA was assessed 4 weeks after surgery.

RESULTS

Data were available for 721/784 eyes (92.0%) of 656 patients aged 60 years or older. ARM lesions were detected in 98 eyes (13.6%) before and 92 eyes (12.8%) after surgery. Sensitivities for detecting late ARM lesions, soft drusen and retinal pigment epithelium abnormalities preoperatively were 100%, 94% and 69%, respectively. Corresponding specificities were 100%, 100% and 77%, respectively. Postoperative VA achieved or remained 6/12 or better in 81.6% of eyes.

CONCLUSION

A high sensitivity and specificity in detecting late ARM lesions and soft drusen preoperatively, and a good postoperative VA outcome is achievable in patients with preoperative early ARM lesions.

Light energy, cataract surgery, and progression of age-related macular degeneration

PURPOSE OF REVIEW

Some studies suggest an association between light exposure and increased risk of advanced age-related macular degeneration. The natural lens serves as a barrier to some of the higher energy light rays. There is some concern that cataract surgery may be contributing to the increase in prevalence of age-related macular degeneration.

RECENT FINDINGS

It has been shown that blue light absorption by retinal pigment epithelium results in free radical formation, leading to cellular injury, and that blue filters can reduce this rate of cell death. Other studies have shown a tendency for pseudophakic eyes to progress to the wet form of age-related macular degeneration more so than their fellow eyes.

SUMMARY

Currently there is no conclusive evidence to support a relation between progression of age-related macular degeneration and cataract surgery. Given that nearly two million cataract extractions are performed yearly, a large randomized controlled study is required to prove or disprove the ability of tinted intraocular lenses to aid in preventing the progression of age-related macular degeneration.

Transmission of light to the aging human retina: possible implications for age related macular degeneration

The purpose of this study is to determine the transmission properties of the anterior segment of the human eye as a function of age and relate those changes to possible consequences for retinal disorders. For this a new method has been developed. This consists of a probe which is inserted into the posterior sclera and detects light passing through the anterior segment. The probe is connected to a CCD spectrophotometer via a fibre optic bundle. Using this, the transmission properties of human cadaver eyes were determined. A young primate anterior segment has a maximum absorption of 365 nm due to the O-beta-glucoside of 3-hydroxykynurenine (3-HKG) in the lens. There is a steep increase in transmission of the human anterior segment at wavelengths longer than 400 nm. With aging there is an increase in absorption throughout the visible such that by the sixth decade only 20% of blue light is transmitted to the retina compared to the young primate eye. The rate of decrease of blue light was similar to the age related change of the ratio of absorbance at 365/320 nm of the lens. (IOVS 41:1454;1999). The age related rate of decrease in the transmission of blue light to the retina was similar to the rate of increase of lipofuscin formation in the retina, and the amount of light absorbed by A2E in the RPE is constant from the second to seventh decade. Although this yellowing is thought to be detrimental to the lens, it would appear to be beneficial to the retina. It was determined that the implantation of a standard IOL after cataract surgery increased the amount of light absorbed by A2-E by approximately a factor of five.

Choroidal neovascularization in myopic eyes after phakic refractive lens and iris-claw lens implantation

PURPOSE

To describe the appearance of choroidal neovascularization (CNV) in two myopic patients after implantation of a phakic refractive lens (PRL) and an iris-claw lens.

METHODS

A PRL was implanted in the left eye of a 35-year-old myopic man. Five weeks later, he reported decreased best-corrected visual acuity (BCVA). Fluorescein angiography revealed juxtafoveal CNV Photodynamic therapy with Visudyne (PDT) was successfully performed, achieving closure of the membrane. BCVA was 20/40 3 months afterwards. An iris-claw lens was implanted in the left eye of a 24-year-old myopic man. BCVA after surgery was 20/40 (SE -0.75). Three years later subfoveal CNV was diagnosed. PDT was performed, achieving complete closure of CNV BCVA was 20/100 3 months after treatment.

CONCLUSIONS

The appearance of CNV in myopic eyes corrected by phakic intraocular lens implantation is a possible complication that must be considered.

Reading performance depending on the type of cataract and its predictability on the visual outcome

PURPOSE

To investigate the influence of various types of cataract on reading performance in a standardized reading test setting.

SETTING

Department of Ophthalmology, University of Vienna, Vienna, Austria.

METHODS

The reading performance of 94 eyes with age-related cataract and normal macular function was evaluated with the Radner Reading Charts preoperatively and 4 weeks after cataract surgery. Distance visual acuity was tested with the ETDRS charts. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, on which NO is nuclear opalescence and NC is nuclear color.

RESULTS

Patients with pure nuclear cataracts (LOCS III: NO/NC 2.1-5) achieved a normally high MRS (99.84% +/- 7.65% of their postoperative MRS): preoperative MRS(1): 190.6 +/- 30.74 words per minute (wpm); postoperative MRS(2): 191.21 +/- 29.36 wpm. Patients with mixed nuclear-cortical cataracts (LOCS III: NO/NC 2.1-5; C>2) preoperatively achieved 96.96% +/- 5.6% of their postoperative MRS (MRS(1): 175.77 +/- 31.54 wpm; MRS(2): 181.34 +/- 30.56 wpm). In dense nuclear cataracts (LOCS III: NO/NC>5), the MRS was significantly reduced, achieving only 72.64 +/- 19.19% of the postoperative MRS (MRS(1): 133.06 +/- 39.43 wpm; MRS(2): 185.76 +/- 40.18 wpm). In posterior subcapsular cataracts, the preoperative MRS (134.1 +/- 33.72 wpm) was significantly lower than postoperatively (191.14 +/- 27.08 wpm).

CONCLUSIONS

In contrast to dense nuclear cataracts and posterior subcapsular cataracts, the preoperative reading speed of patients with pure nuclear or nuclear-cortical cataracts was normal at large print sizes. The preoperative evaluation of reading acuity and speed with standardized reading tests can therefore be used to estimate the postoperative reading performance in the latter 2 types of cataract.

Blue light-absorbing intraocular lens and retinal pigment epithelium protection in vitro

PURPOSE

To compare the Alcon AcrySof Natural (SN60AT) and AcrySof (SA60AT), the AMO Sensar (AR40e) and ClariFlex, and the Pfizer CeeOn Edge 911A intraocular lenses (IOLs) as to their ability to protect retinal pigment epithelial (RPE) cells from light damage mediated by the lipofuscin fluorophore A2E.

SETTING

Department of Ophthalmology, Columbia University, New York, New York, USA.

METHODS

Cultured human RPE cells (ARPE-19 cell line) that had accumulated A2E were exposed to blue (430 nm +/- 30), green (550 +/- 10 nm), or white (390 to 750 nm) light with and without an IOL in the light path.

RESULTS

The blue light-absorbing AcrySof Natural IOL was associated with significant reduction (78% to 82%; P<.01) in the death of A2E-laden RPE that were exposed to blue, white, and green light. The decrease in the incidence of cell death was greater in magnitude than would be expected from the amount of light that was absorbed by the IOL. The considerably smaller declines in cell death observed with the AcrySof, Sensar, ClariFlex, and CeeOn Edge IOLs were likely due to nonspecific reductions in light transmittance.

CONCLUSIONS

By absorbing blue light, the AcrySof Natural IOL shields RPE cells that have accumulated the aging lipofuscin fluorophore A2E from the damaging effects of light. A long-term population-based clinical trial would determine whether a blue light-absorbing IOL can reduce the risk for or progression of age-related macular degeneration.

Epidemiology of age-related maculopathy: a review

Age-related maculopathy (ARM) is a degenerative disease of the retina and the leading cause of incurable blindness and visual impairment in industrialized countries. By definition, ARM is confined to the age-category above 50 years. The aetiology of ARM is still unknown, despite intensive research on many fronts. In this paper, we provide a review of the epidemiology of ARM. The most prominent findings were an exponential increase in frequency with age, a significant familial and genetic component, and a strong association with smoking. Other risk factors that were found less consistently were atherosclerosis, low intake of antioxidant nutrients, and cataract extraction. Future studies, both observational and experimental, will hopefully identify more risk factors that are amenable to prevention.

How much blue light should an IOL transmit?

Older, and even some modern, intraocular lenses (IOLs) transmit potentially hazardous ultraviolet radiation (UVR) to the retina. In addition, IOLs transmit more blue and green light to the retina for scotopic vision than the crystalline lenses they replace, light that is also potentially hazardous. The severity of UVR-blue type phototoxicity increases with decreasing wavelength, unlike the action spectrum of blue-green type retinal phototoxicity and the luminous efficiency of scotopic vision which both peak in the blue-green part of the optical spectrum around 500 nm. Theoretically, UVR+blue absorbing IOLs provide better retinal protection but worse scotopic sensitivity than UVR-only absorbing IOLs, but further study is needed to test this analysis. UVR is potentially hazardous and not useful for vision, so it is prudent to protect the retina from it with chromophores in IOLs. Determining authoritatively how much blue light an optimal IOL should block requires definitive studies to determine (1) the action spectrum of the retinal phototoxicity potentially involved in human retinal ageing, and (2) the amount of shorter wavelength blue light required for older adults to perform essential activities in dimly lit environments.

Cataract surgery and the 5-year incidence of late-stage age-related maculopathy

PURPOSE

To assess whether cataract surgery in older persons increases risk for the development of late-stage age-related maculopathy (ARM).

DESIGN

Combined analysis of longitudinal data from two population-based cohorts, the Beaver Dam Eye Study and Blue Mountains Eye Study.

PARTICIPANTS

The Beaver Dam Eye Study examined 4926 persons aged 43 years or older at baseline and re-examined 3684 after 5 years. The Blue Mountains Eye Study examined 3654 persons aged 49 years or older at baseline and re-examined 2335 after 5 years.

METHODS

The two studies used similar protocols for retinal photography and photographic grading. We defined incident late-stage ARM as the development of neovascular ARM or geographic atrophy in eyes without either lesion type at baseline that was confirmed by consensus between the study investigators. Nonphakic eyes included eyes that were aphakic or pseudophakic at baseline. Eye-specific data were analyzed. Age- and study site-adjusted relative risks were calculated using the Cochran-Mantel-Haenszel method. Multivariate-adjusted odds ratios (ORs) were also estimated using generalized estimating equation models.

RESULTS

Of the 6019 participants examined after 5 years, 11,391 eyes were considered at risk for developing late-stage ARM, including 315 nonphakic and 11,076 phakic eyes. Late-state ARM (either neovascular ARM or geographic atrophy) developed in 6.0% to 7.5% of nonphakic eyes (10 of 168 right and 11 of 147 left eyes), compared with 0.7% of phakic eyes (40 of 5504 right and 37 of 5572 left eyes) during the 5-year period. Age- and study site-adjusted 5-year relative risks were 2.8 (95% confidence interval [CI], 1.6-5.1) for right and 3.7 (95% CI, 2.1-6.4) for left eyes. After further adjustment for gender, smoking, and the presence of indistinct or reticular drusen or pigmentary abnormalities at baseline, nonphakic eyes had a substantially higher risk for developing either late-stage ARM lesion compared with phakic eyes, OR = 5.7 (95% CI, 2.4-13.6).

CONCLUSIONS

Pooled findings from these two large population-based cohorts support the hypothesis that cataract surgery in older persons may be associated with an increased subsequent risk for developing late-stage ARM, particularly neovascular ARM.

Incidence of Retinal Disease Following Refractive Surgery in 9,239 Eyes

PURPOSE

To analyze the appearance, incidence, and characteristics of retinal diseases in myopic patients after refractive surgery.

METHODS

We studied retinal disease observed in 9,239 consecutive eyes (5,099 patients) after refractive surgery. Photorefractive keratectomy (PRK) was used to correct myopia in 5,936 eyes (3,184 patients, mean age 30.5 +/- 8.9 years); mean spherical equivalent refraction was -4.71 +/- 2.80 D. Laser in situ keratomileusis (LASIK) was used to correct myopia in 3,009 eyes (1,734 patients, mean age 32.0 +/- 7.8 years); mean spherical equivalent refraction was -13.5 +/- 3.30 D. An anterior chamber phakic intraocular lens (PIOL) was implanted to correct myopia in 294 eyes (181 patients, mean age 32.6 +/- 7.3 yr) with a mean spherical equivalent refraction of -18.5 +/- 5.00 D.

RESULTS

Retinal detachment occurred at a mean 53.6 +/- 41.4 months after PRK in 9 eyes (0.15%), 24.6 +/- 20.4 months after LASIK in 11 eyes (0.36%), and 20.5 +/- 17.4 months after anterior chamber PIOL implantation in 12 eyes (4.08%). Choroidal neovascularization occurred a mean 26 months after PRK in 1 eye (0.01%), mean 30.2 +/- 19.3 months after LASIK in 10 eyes (0.33%), and mean 49.0 +/- 33.5 months after PACL implantation in 7 eyes (2.38%). One patient developed a macular hole 12 months after LASIK and another patient developed a macular hemorrhage immediately after LASIK. Epiretinal membrane appeared in one patient 19 months after anterior chamber PIOL implantation.

CONCLUSION

There was no relationship between PRK for myopia and retinal disease. LASIK for correction of myopia was followed by a low incidence of retinal disease; additional study is necessary to assess the true impact of the suction ring in the myopic eye. Implantation of an anterior chamber PIOL to correct high myopia was followed by a low incidence of choroidal neovascularization, a high incidence of retinal detachment, similar to other intraocular interventions in highly myopic patients.

A2E-epoxides damage DNA in retinal pigment epithelial cells. Vitamin E and other antioxidants inhibit A2E-epoxide formation

The autofluorescent pigments that accumulate in retinal pigment epithelial cells with aging and in some retinal disorders have been implicated in the etiology of macular degeneration. The major constituent is the fluorophore A2E, a pyridinium bisretinoid. Light-exposed A2E-laden retinal pigment epithelium exhibits a propensity for apoptosis with light in the blue region of the spectrum being most damaging. Efforts to understand the events precipitating the death of the cells have revealed that during irradiation (430 nm), A2E self-generates singlet oxygen with the singlet oxygen in turn reacting with A2E to generate epoxides at carbon-carbon double bonds. Here we demonstrate that A2E-epoxides, independent of singlet oxygen, exhibit reactivity toward DNA with oxidative base changes being at least one of these lesions. Mass spectrometry revealed that the antioxidants vitamins E and C, butylated hydroxytoluene, resveratrol, a trolox analogue (PNU-83836-E), and bilberry extract reduce A2E-epoxidation, whereas single cell gel electrophoresis and cell viability studies revealed a corresponding reduction in the incidence of DNA damage and cell death. Vitamin E, a lipophilic antioxidant, produced a more pronounced decrease in A2E-epoxidation than vitamin C, and treatment with both vitamins simultaneously did not confer additional benefit. Studies in which singlet oxygen was generated by endoperoxide in the presence of A2E revealed that vitamin E, butylated hydroxytoluene, resveratrol, the trolox analogue, and bilberry reduced A2E-epoxidation by quenching singlet oxygen. Conversely, vitamin C and ginkgolide B were not efficient quenchers of singlet oxygen under these conditions.

Cataract surgery in patients with age-related macular degeneration: one-year outcomes

PURPOSE

To determine whether patients with age-related macular degeneration (ARMD) benefit from cataract surgery and to assess the risk of progression of preexisting maculopathy 4 and 12 months postoperatively.

SETTING

Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh, Scotland.

METHODS

Two groups of patients were evaluated prospectively. The study group comprised patients with ARMD scheduled to have cataract surgery (n = 40). The control group comprised patients with ARMD not having cataract surgery (n = 43). Patients were assessed at baseline (preoperatively) and 4 and 12 months postoperatively. Assessment included visual function tests and quality of life (QoL) measures. The mean values for each item tested were obtained for each group at each visit, and comparisons between visits were done using the Wilcoxon signed rank test.

RESULTS

There were significant benefits of cataract surgery in terms of visual function and QoL measures at 4 and 12 months. There was no increased risk of progression of maculopathy in the study group. There were no significant differences in the items tested in the control group.

CONCLUSIONS

One year postoperatively, QoL benefits were maintained in the study group and there was no increased risk of progression of maculopathy in patients with mild and moderate degrees of ARMD. Larger numbers of patients must be assessed prospectively for longer periods to determine the relative risk of progression of different stages of ARMD after cataract surgery.

Choroidal neovascularization in phakic eyes with anterior chamber intraocular lenses to correct high myopia

PURPOSE

To analyze the appearance, incidence, and characteristics of choroidal neovascularization (CNV) in patients with high myopia corrected by implantation of a phakic anterior chamber intraocular lens (PACL).

SETTING

University Miguel Hernández, Instituto Oftalmológico de Alicante, Alicante, Spain.

METHODS

The CNV observed in 294 consecutive eyes (181 patients) implanted with a PACL for the correction of high myopia (-7.0 to -38.0 diopters) was studied. The mean follow-up was 50.6 months +/- 32.8 (SD) (range 6 to 120 months).

RESULTS

Choroidal neovascularization occurred in 5 eyes (1.70%); 3 eyes were in women, and 2 were in men. The interval between PACL implantation and CNV was 63.2 +/- 27.3 months (range 18 to 87 months). The CNV was subfoveal in 4 eyes and juxtafoveal in 1 case. The mean best spectacle-corrected visual acuity (BSCVA) after PACL implantation and before the appearance of CNV was 0.53 +/- 0.18 (range 0.4 [20/50] to 0.8 [20/25]); after CNV appeared, it was 0.26 +/- 0.18 (range 0.05 [20/400] to 0.5 [20/40]), a statistically significant difference (P =.001, paired Student t test). In 2 cases, the CNV was treated with photodynamic therapy (PDT); in the other 3 cases, PDT was rejected. The cumulative risk for CNV (Kaplan-Meier survival analysis) in highly myopic patients corrected by PACL implantation was 0.43% at 18 months and 5.4% at 87 months.

CONCLUSIONS

Implantation of a PACL to correct high myopia was followed by a small incidence of CNV (cumulative risk of 5.4% at 87 months). The appearance of CNV was followed by a significant decrease in BSCVA.

Cataract extraction and age-related macular degeneration: associations, diagnosis and management

Both cataract and age-related macular degeneration (ARMD) are common findings in our aging population. At issue is the progression of ARMD following cataract extraction. The purpose of this paper is to review the data relevant to this subject and to offer suggestions as to the management of cataract associated with macular degeneration. Published data are reviewed and an attempt is made to interpret the results. Topics discussed include the epidemiology and association between the incidence of cataract and ARMD, the role of photo-oxidative damage and inflammation in the pathogenesis of ARMD, and the possible contribution of cataract extraction to the exacerbation and acceleration of ARMD through increased photo-oxidative damage and intraocular inflammation. Recommendations for the cataract surgeon and specialist are formulated on the basis of existing literature.

Age-related macular degeneration: epidemiology and optimal treatment

Age-related macular degeneration (AMD) is a common macular disease affecting elderly people in the Western world. It is characterised by the appearance of drusen in the macula, accompanied by choroidal neovascularisation (CNV) or geographic atrophy. The disease is more common in Caucasian individuals than in pigmented races. In predominantly Caucasian populations, the age-standardised prevalence of AMD in at least one eye is 7760 cases per million. The age-standardised cumulated 1-year incidence of AMD in at least one eye is 1051 cases per million individuals. AMD is the most important single cause of blindness among Caucasian individuals in developed countries. Blindness resulting from AMD rarely occurs before age 70, and most cases occur after age 80. The age-standardised 1-year incidence of legal blindness resulting from AMD is 212 cases per million. Two-thirds of AMD cases have CNV (exudative cases); the remainder has only geographic atrophy. In cross-sectional population-based studies about 45% of eyes with AMD have visual acuity reduced to 20/200 or worse. This is true both for exudative AMD and pure geographic atrophy. Age and genetic predisposition are known risk factors for AMD. Smoking is probably also a risk factor. Preventive strategies using macular laser photocoagulation are under investigation, but their efficacy in preventing visual loss is as yet unproven. There is no treatment with proven efficacy for geographic atrophy. Optimal treatment for exudative AMD requires a fluorescein angiographic study and a physician capable of interpreting it. For CNV not involving the foveal centre, the only evidence-based treatment is laser photocoagulation. For AMD cases with subfoveal CNV, good visual acuity, and predominantly classic fluorescence pattern on fluorescein angiography, photodynamic therapy with verteporfin is the treatment of choice. Photodynamic therapy is also effective in eyes with pure occult CNV and evidence of recent disease progression. For new subfoveal CNV with poor vision and recurrent CNV, laser photocoagulation can be considered.

Cataract surgery in patients with retinal disease

Retinal disease and cataracts frequently are associated with one another. Cataract formation can occur following pars plana vitrectomy and pneumatic retinopexy. Conversely, cataract surgery may exacerbate existing retinal disease, such as diabetic retinopathy, macular degeneration, and uveitis. Finally, cataract surgery can lead to retinal disease de novo, such as cystoid macular edema. A review of the medical literature was performed for all articles published between August 1st, 2000 and July 31st, 2001 on the topic of cataract surgery in patients with retinal disease. The authors selected ten articles that were most relevant to the practicing ophthalmologist for inclusion in this review. Topics of interest included age related macular degeneration, retinal detachment, macular hole, diabetic retinopathy, uveitis, and cystoid macular edema.