Can Cataract Surgery Cause Macular Degeneration?

Cataract surgery does not cause disease progression in people with age-related macular degeneration (AMD). The Age-Related Eye Disease Study 2 (AREDS2) evaluated participants with AMD for up to 10 years and found that those who had cataract surgery showed no increased risk of AMD progression versus those who did not. This is good news for those with AMD who may benefit from cataract surgery[1][4].

While most evidence indicates that cataract surgery does not make macular degeneration worse, the surgery does carry some low risk of faster progression of early-to-late AMD with longer follow-up of patients. However, the overall consensus is that cataract surgery can improve vision in those who are candidates for the procedure[2].

According to consultant ophthalmologist and expert cataract ophthalmic surgeon David Malitz, if the cataracts are “clinically significant,” meaning that removing them would make your vision better, cataract surgery may be beneficial, regardless of whether you have AMD or not. However, it’s important to have realistic expectations, as cataract surgery may not fully restore central vision affected by AMD[5].

In some cases, the cataract is so dense that the severity of the underlying macular degeneration is not appreciated due to poor visualization through the cataract on the examination.   After the surgery, the vision may not improve and a detailed examination of the central retina may show macular damage.   The surgery did not cause this, but allows for the diagnosis of this condition.   Lay people may interpret this as a causation when in fact this is not the case.

In conclusion, while there is a low risk of faster progression of AMD with longer follow-up after cataract surgery, the overall evidence suggests that cataract surgery does not make macular degeneration worse. It can improve vision in individuals with both conditions, but the potential benefits and risks should be carefully evaluated by an ophthalmologist on a case-by-case basis[1][2][4][5].

Citations:
[1] https://www.aao.org/eye-health/tips-prevention/macular-degeneration-cataract-surgery-are-they-com
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646653/
[3] https://www.brightfocus.org/macular/article/cataracts-and-age-related-macular
[4] https://www.nei.nih.gov/about/news-and-events/news/cataract-surgery-does-not-cause-disease-progression-people-amd
[5] https://www.macularsociety.org/about/media/news/2022/september/cataract-surgery-and-macular-degeneration-your-questions-answered/