Association between Cataract Surgery and Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

Abstract

Purpose. We performed a systematic review and meta-analysis to evaluate the association between cataract surgery and the development and progression of AMD. Methods. This meta-analysis was registered at PROSPERO (CRD42017077962). We conducted a systematic literature search in August 2020 in Embase and PubMed and included cohort studies, case-control studies, or randomized controlled trials (RCTs) if they examined the association between cataract surgery and AMD. Odds ratio (OR) was used as a measure of the association with a random effect model. The analysis was further stratified by factors that could affect the outcomes. Results. 15 studies were included in this study. In the overall analysis, cataract surgery was significantly associated with the incidence of late AMD (OR, 1.80; 95% CI, 1.26–2.56; P = 0.001), particularly geographic atrophy (OR, 3.20; 95% CI, 1.90–5.39; P ≤ 0.001). No significant associations were observed between cataract surgery and the incidence of early AMD. Subgroup analysis showed that the OR for incidence of early and late AMD was significantly higher for cataract surgery performed more than 5 years compared with less than 5 years. We also found an increased risk of progression of AMD after cataract surgery performed more than 5 years (OR, 1.97; 95% CI, 1.29–3.01; P = 0.002). Conclusions. Our results suggest that cataract surgery may be associated with an increased risk of late AMD development and AMD progression. In addition, increasing the follow-up time since cataract surgery may further increase the risk for the development and progression of AMD. In the future, prospective multicenter studies with well-designed RCTs are required to confirm our findings.

Considerations for the Identification and Management of Geographic Atrophy: Recommendations from an Expert Panel

“…Additionally, there was consensus that anterior segment specialists should be able to identify GA to help improve patient expectations following cataract surgery, as it may be associated with an increased risk of AMD progression. 8 …”

Causal Associations of Glaucoma and Age-Related Macular Degeneration with Cataract: A Bidirectional Two-Sample Mendelian Randomisation Study

“…UV ray exposure is a shared risk factor for AMD and cataract, and because cataract surgery (intraocular lens) increases UV ray exposure in the macular area, the prevalence of AMD may consequently increase, according to the meta-analysis results [53]. Thus, the abovementioned factors are thought to exert an influence in terms of the prevention of AMD by cataract, thereby counteracting the cataract-inducing effect of aging.…”

“…In addition, the C-reactive protein is a hallmark lipid in drusen [77]. As the severity of AMD is higher than that of cataract, whether cataract surgery causes AMD has been a major focus of many studies [53,[78][79][80]. Consequently, research on whether AMD causes cataract formation is limited.…”