Editor,—We were interested to read Shuttleworth and colleagues’ recent paper on the benefit of cataract surgery on patients with age related macular degeneration (ARMD).1The article suggested that the prognosis of patients with ARMD after cataract extraction was not as poor as had been previously thought and that more than two thirds of patients benefit from surgery and consider the procedure worthwhile.

Previous research has suggested that cataract surgery may increase the progression of ARMD. Van de Schaft et al 2 reported an increased prevalence of disciform macular degeneration in postmortem pseudophakic eyes with IOL implants. The Beaver Dam Eye Study3 indicated a statistically significant relation between cataract surgery at baseline and the incidence and progression of disciform ARMD. Pollacket al 4 reported a 19% increase in progression following surgery on the first eye of patients with moderate, bilateral ARMD. In a further study5 they reported an even higher incidence of progression (24%) when the second eyes of patients with previous uneventful postoperative maculopathic course were operated on.

In 1997, we performed a pilot study to assess the feasibility of a major prospective study comparing the progression of ARMD on patients …