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A matched analysis of 80,106 eyes in the American Academy of Ophthalmology’s IRIS Registry found a modest association between cataract surgery and conversion from dry AMD to neovascular AMD. The association was strongest during the first year and was no longer statistically significant after four years; the observational study cannot show that surgery caused progression.
A study of 80,106 eyes with dry age-related macular degeneration found that eyes whose patients underwent cataract surgery had a modestly higher rate of conversion to neovascular AMD than matched eyes without surgery. The association was strongest during the first year after the procedure and was no longer statistically significant after four years, according to researchers reporting in Ophthalmology. Because the analysis was observational, it does not establish that surgery caused the progression.
Researchers analyzed data from the American Academy of Ophthalmology’s IRIS Registry, covering January 2016 through December 2022. The study included patients aged 55 or older with early or intermediate dry AMD who had not yet undergone cataract surgery at baseline. After matching, the analysis compared 40,053 eyes in each group: one group underwent surgery and the other did not.
Across follow-up, surgery was associated with a 22% higher hazard of conversion to neovascular AMD, also called wet AMD (hazard ratio 1.22; 95% confidence interval 1.16 to 1.30). In the time-varying analysis, the association was larger during the first year, when the hazard ratio reached 2.5, then declined. The difference was statistically nonsignificant after four years.
At six years, cumulative incidence was 17.7% among eyes in the surgery group and 15.2% among those without surgery, an absolute difference of 2.5 percentage points. The reported association was weaker for eyes with intermediate-stage AMD. The researchers said the early pattern could reflect patients having more advanced or symptomatic disease before surgery, or increased monitoring after the procedure revealing disease that was already developing.
Follow-Up After Cataract Surgery
The findings address a concern for people who have both cataracts and dry AMD: whether removing a cataract might speed progression to neovascular disease. The analysis found a small difference between matched groups, with the largest association early after surgery and a less than three percentage point absolute difference at six years. Those figures describe the study groups; they do not predict an individual patient’s outcome.
For clinical care, the authors and the invited commentators point to careful assessment and regular follow-up for patients with AMD around the time of cataract surgery. Neovascular AMD can affect vision, so monitoring may help clinicians identify a change and evaluate it. The study does not show that avoiding cataract surgery would prevent progression, and it does not settle how much of the observed association reflects the procedure itself.
Cataract surgery can improve vision, including for some people who also have AMD. The results therefore add information for patient counseling rather than establishing a reason to deny or delay surgery. Decisions still need to account for the patient’s eye findings, visual needs and overall clinical circumstances.
Why Earlier Studies Differed
AMD affects the macula, the part of the retina responsible for central vision. Dry, or non-neovascular, AMD is the more common form; the source report says about 80% of people with AMD have this type. Neovascular AMD involves abnormal blood vessel growth and is also called wet AMD. Cataracts cloud the eye’s lens, and surgery removes the cloudy lens to improve vision.
Earlier research did not produce a consistent answer on whether cataract surgery is linked to AMD progression. Large population studies conducted more than 20 years ago reported increased risk of late AMD after surgery, while smaller cross-sectional studies found no association. A systematic review reported a significant correlation, with a stronger association over longer follow-up. The study authors cited differences in study design, sample size, follow-up and statistical methods, as well as changes in surgical techniques, as possible reasons for varied results.
The IRIS Registry analysis sought to examine the question in a large contemporary dataset. Matching the two groups helps make their measured characteristics more comparable, but it cannot remove every possible difference between patients who did and did not have surgery. The study’s observational design remains central to interpreting its results.
“The findings of this study demonstrated a slight increased risk of conversion to nvAMD after cataract surgery.”
— Grayson Armstrong, MD, MPH, and colleagues
Cause of the Early Association
The analysis cannot establish whether cataract surgery itself contributes to conversion, because patients were not randomly assigned to have surgery. The early increase could reflect closer postoperative surveillance, which might identify neovascular AMD sooner, or underlying disease that contributed to vision loss and led to surgery. The authors raised these possibilities but did not determine which explanation accounts for the pattern.
The source report does not provide enough detail to assess all possible unmeasured differences between the groups or how the results apply to every AMD stage and patient. The six-year incidence figures are group-level outcomes, and the study does not establish an individual’s risk. The extent to which modern surgical methods, differences in follow-up, or the severity of AMD explain earlier conflicting findings also remains unsettled.
Monitoring and Further Evidence
The study’s practical message is to discuss the potential association with patients who have dry AMD and cataracts, then plan regular eye follow-up after surgery. The commentators said monitoring may need to be more frequent following surgery, while noting that follow-up should reflect the patient’s circumstances. The source material does not specify a single schedule or announce a new clinical guideline.
Further research would be needed to clarify how much of the early association comes from surgery, pre-existing disease or increased detection. For now, the registry findings can inform counseling, but clinicians and patients must weigh the potential benefits of improved vision against the patient’s eye health and care needs.
Key Questions
Did the study show that cataract surgery causes wet AMD?
No. It found an association in observational registry data, which cannot establish that surgery caused conversion.
How large was the difference at six years?
Cumulative incidence was 17.7% in the surgery group and 15.2% in the group without surgery, a 2.5 percentage point difference.
When was the association strongest?
The time-varying analysis found the strongest association during the first year after surgery. It declined over time and was statistically nonsignificant after four years.
What did the researchers recommend for patients?
The report supports careful evaluation and regular follow-up for patients with AMD after cataract surgery. It does not set a specific visit schedule or say that surgery should be avoided.
Source: rss
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