Q: Will cataract surgery be of benefit to me if I have macular degeneration (AMD)? Is there a way to tell how much of my vision loss is due to the cataract rather than the AMD?
A: Cataracts and age-related macular degeneration, AMD, are the leading causes of visual impairment in older adults worldwide. Additionally, there are an increasing number of patients who have coexisting cataracts and AMD. Treating cataracts in a patient with AMD presents some unique challenges since both conditions contribute to decreased visual acuity but in different ways. The cataract is a clouding of the lens at the front part of the eye causing blurry vision whereas the AMD damages the retina at the back of the eye and affects one’s central vision. Each condition therefore must be assessed separately while also considering their effect on one another.
Prior to cataract surgery for those who also have AMD, there should be a thorough exam of both the retina and macula to get an idea of how much of the vision loss may be attributed to each of the cataracts and the AMD. Testing to help with this assessment can include ocular coherence tomography (OCT), glare testing, fundus and/or retinal photos, and an accurate history of both conditions including diagnosis date, rate of development, stability of AMD, and documentation of vision changes.
With this non-routine cataract surgery involving a secondary condition such as AMD, it is essential to have a straightforward discussion between the patient and the surgeon explaining the realistic visual potential after cataract surgery. The key point to understand is that there are at least two conditions affecting the patient’s vision so removing the cataract may not provide ‘ideal’ vision but it may help to improve the quality of your vision for daily activities. Having another family member present during this discussion will help ensure that all the facts are covered and understood including the risks and benefits and likely outcomes after surgery.
For those with AMD, dry or wet, having cataract surgery doesn’t usually present any greater risks. With accurate testing and evaluation, along with proper precautions and measures, AMD should not be a contraindication to cataract surgery.