Can Cataract Surgery Make Macular Degeneration Worse?  

Posted by: Philadelphia Eye Associates in Eye Health on December 4, 2022

Written by Jackie Mandell, MD

Many patients come to our office with both cataracts and macular degeneration. The haziness from a cataract and the loss of central vision from macular degeneration both contribute to vision loss — to have clear vision, we need to have both a clear lens and a healthy retina.  

The first step is to determine the severity of the cataract and the macular degeneration. This is accomplished through a dilated eye exam and a special retinal photograph called an OCT, or optical coherence tomography. The OCT uses light reflected off the retina to create a cross-sectional view of the retina that can be displayed on a computer screen. (This uses light, not radiation like an x-ray.) This can help the doctor determine the severity of the vision loss from macular degeneration.

In a patient with both cataracts and macular degeneration, the visual improvement from cataract surgery can be limited by retinal damage from macular degeneration. However, removing a cataract still can improve the amount of light entering the eye, the peripheral vision, and a doctor’s ability to monitor and treat other diseases in the back of the eye.  

There was prior concern of whether inflammation from cataract surgery could accelerate progression of macular degeneration. The largest, most definitive study that addressed this question was published by the NIH (National Institutes of Health) in 2021. It monitored over 4,500 eyes for 10 years. The good news is that with modern cataract surgery, there was no increased risk of progression of macular degeneration. In other words, cataract surgery does not accelerate progression of macular degeneration. This is encouraging news for patients with macular degeneration who might benefit from cataract surgery. Of course, it is always recommended to have a full evaluation with your ophthalmologist to determine a patient-specific plan for your optimal eye health and best vision.

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