How are cataracts and age-related macular degeneration (AMD) managed when they coexist due to the age factor?

Management of Coexisting Cataracts and Age-Related Macular Degeneration

Proceed with cataract surgery when visually significant cataracts coexist with AMD, as surgery improves visual acuity without increasing the risk of AMD progression. 1

Cataract Surgery Decision-Making in AMD Patients

The primary concern when these conditions coexist is whether cataract surgery will worsen underlying AMD. The evidence clearly addresses this:

• Cataract surgery does not increase the risk of AMD progression and should be performed when cataracts are visually significant. 1
• Visual acuity improves significantly at 6-12 months post-surgery, with gains of 6.5-7.5 letters compared to unoperated eyes. 2
• The risk of progression to exudative (wet) AMD after cataract surgery is not increased, with no significant difference between operated and unoperated eyes. 3, 2

Specific Management Algorithm

For Cataract Management:

• Perform cataract surgery when cataracts cause visually significant impairment, regardless of AMD presence. 3, 1
• Reassure patients that surgery will not accelerate their AMD. 1
• Vision-related quality of life improves significantly after cataract surgery in AMD patients. 3

For AMD Management:

• Treat exudative (wet) AMD with anti-VEGF therapy regardless of cataract status. 4
• Anti-VEGF injections (intravitreal) represent the best available treatment for wet AMD. 4
• Treatment requires repeated intravitreal injections with ongoing monitoring. 4

Critical Post-Surgical Monitoring

Vigilant follow-up after cataract surgery is essential, not because surgery increases AMD risk, but because the natural progression rate of AMD remains high. 1

• Patients with intermediate AMD or advanced AMD in the fellow eye have high natural progression rates to late AMD. 1
• Monitor specifically for signs of choroidal neovascularization development. 1
• Early detection allows prompt initiation of anti-VEGF therapy if wet AMD develops. 1

Common Pitfalls to Avoid

• Do not delay cataract surgery due to fear of AMD progression—this concern is not supported by evidence. 1
• Do not assume visual improvement from cataract surgery alone will be sufficient if wet AMD is present or develops—anti-VEGF therapy is still required. 4
• Ensure appropriate referral timing to ophthalmology for both conditions, as PCPs play a critical role in early identification. 5