Exacerbation of Age-Related Macular Degeneration Following Cataract Extraction

ABSTRACT: Exacerbation of macular degeneration from nonexudative to exudative disease following cataract extraction has been reported infrequently. We report two cases, one in an 87-year-old male and another in a 71-year-old male. It is most likely that the hypotony associated with cataract extraction precipitates leakage of unsuspected choroidal neovascularization causing exacerbation of the macular degeneration.     

Association between Previous Cataract Surgery and Age-Related Macular Degeneration

Purpose: To assess the association between age-related macular degeneration (AMD) and previous cataract surgery. Methods: We studied 17,987 randomly selected participants from the Korea National Health and Nutrition Examination Survey who were aged ≥40 years and underwent additional ophthalmologic examinations in 2008?12. The associations between previous cataract surgery and early/late AMD were identified using multivariate logistic regression analysis of data from right or left eyes. Clustered multivariate logistic regression analysis was performed using both eyes to assess inter-eye correlation in same subject. Previous cataract surgery and cataract subtypes were based on slit-lamp examination without pupil dilation. Early and late AMD diagnoses were based on non-mydriatic digital retinal image. Results: By univariate logistic regression, both early and late AMD prevalence were higher in subjects with pseudophakia/aphakia compared to subjects with cataract as a reference group, or subjects with phakic eye (including clear lens) as a reference group. In univariate logistic regression, both early and late AMD prevalence were higher in eyes with cataract or pseudo/aphakia compared to eyes with clear lens. However, after adjusting for age with multivariate logistic regression, all statistically significant differences in AMD prevalence among subgroups disappeared. Conclusions: We found no association between the previous cataract surgery and increased early/late AMD risk in our representative, large, national patient database. This suggests that increasing age, and not cataract surgery history, is predictive of AMD risk. These findings are limited by cross-sectional study and need to be replicated by other longitudinal observational studies.     

Mimickers of Age-Related Macular Degeneration

In the Western World, the leading cause of irreversible blindness is Age- Related Macular Degeneration (ARMD). It can have significant visual impairment, and it is important that the practicing ophthalmologist is knowledgeable in the diagnosis and treatment of ARMD. Equally important is knowledge in the diagnosis of other disease entities that may mimic ARMD, as this may change the prognosis, treatment and visual outcome of patients. This article discusses those diseases that mimic ARMD and their distinguishing features.     

Imaging in Neovascular Age-Related Macular Degeneration

Imaging plays an essential role in the diagnosis and treatment of age-related macular degeneration (AMD). This review describes the imaging modalities most commonly employed by ophthalmologists caring for patients with neovascular AMD. Imaging modalities discussed include fluorescein angiography, optical coherence tomography, indocyanine green angiography, and fundus autofluorescence.     

Australian Prospective Study of Cataract Surgery and Age-Related Macular Degeneration: Rationale and Methodology

Background: Cataract surgery is the most frequently performed ophthalmic procedure worldwide. While benefits gained from cataract surgery outweigh surgical risks, there have been concerns that older persons may have an increased risk of developing age-related macular degeneration (AMD) after cataract surgery. Objective: The Australian Prospective Study of Cataract Surgery and Age-Related Macular Degeneration Study aims to assess the risk of AMD in a large cohort of older patients following cataract surgery. The current report describes the study rationale, design and methodology. Design: Longitudinal studyParticipants: Approximately 2000 cataract surgical patients aged 65 years or older are being recruited from both public and private sources in western Sydney, Australia.Methods: At study visits, participants are interviewed using standardized questionnaires to obtain information on demographic, medical, and ocular conditions and AMD risk factors, together with data on general health and vision-related quality of life. Eye examinations include visual acuity, intraocular pressure, keratometry and A-scan measurements, plus lens and retinal photography, following pupil dilatation. Retinal photographs taken before cataract surgery, and at 1, 6, 12, and 24 months after surgery are graded for early and late AMD lesions, using the Wisconsin age-related maculopathy grading system. The 1-month post-operative retinal photographs supplement the baseline macular assessment for cases in which cataract occludes a clear view of the macula pre-operatively. It is intended that study participants will be followed for up to five years post-operatively to clarify the question of whether aphakic or pseudophakic, compared to phakic eyes, have a greater risk of developing AMD.     

Nutritional Supplementation and Age-Related Macular Degeneration

The prevalence of Age-related macular degeneration (AMD) is increasing as the population of elderly in the United States grows. Currently the pathogenesis is not fully understood, however oxidative injury is felt to play a significant role. The Age-Related Eye Disease Study (AREDS) established that a supplemental combination of dietary antioxidants of zinc, β-carotene, vitamin C and vitamin E slowed progression of AMD. Recently lutein, zeaxanthin, B vitamins, and omega-3 fatty acids have also been reported to decrease AMD progression, while vitamin E and β-carotene where found to increase the risk of late AMD. AREDS2 is currently underway, further examining the effects of omega-3 fatty acids, carotenoids, and the original AREDS formulation. While awaiting the results of AREDS2, it is important to understand the evidence currently available, so that physicians can safely advise patients today. This review examines the most current literature available exploring nutritional supplementation in age-related macular degeneration.