Elsevier

Ophthalmology

Volume 110, Issue 10, October 2003, Pages 1960-1967
Ophthalmology

Original article
Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: Pooled findings from the Beaver Dam and Blue Mountains eye studie

https://doi.org/10.1016/S0161-6420(03)00816-9Get rights and content

Abstract

Purpose

To assess whether cataract surgery in older persons increases risk for the development of late-stage age-related maculopathy (ARM).

Design

Combined analysis of longitudinal data from two population-based cohorts, the Beaver Dam Eye Study and Blue Mountains Eye Study.

Participants

The Beaver Dam Eye Study examined 4926 persons aged 43 years or older at baseline and re-examined 3684 after 5 years. The Blue Mountains Eye Study examined 3654 persons aged 49 years or older at baseline and re-examined 2335 after 5 years.

Methods

The two studies used similar protocols for retinal photography and photographic grading. We defined incident late-stage ARM as the development of neovascular ARM or geographic atrophy in eyes without either lesion type at baseline that was confirmed by consensus between the study investigators. Nonphakic eyes included eyes that were aphakic or pseudophakic at baseline. Eye-specific data were analyzed. Age- and study site–adjusted relative risks were calculated using the Cochran-Mantel-Haenszel method. Multivariate-adjusted odds ratios (ORs) were also estimated using generalized estimating equation models.

Results

Of the 6019 participants examined after 5 years, 11,391 eyes were considered at risk for developing late-stage ARM, including 315 nonphakic and 11,076 phakic eyes. Late-state ARM (either neovascular ARM or geographic atrophy) developed in 6.0% to 7.5% of nonphakic eyes (10 of 168 right and 11 of 147 left eyes), compared with 0.7% of phakic eyes (40 of 5504 right and 37 of 5572 left eyes) during the 5-year period. Age- and study site–adjusted 5-year relative risks were 2.8 (95% confidence interval [CI], 1.6–5.1) for right and 3.7 (95% CI, 2.1–6.4) for left eyes. After further adjustment for gender, smoking, and the presence of indistinct or reticular drusen or pigmentary abnormalities at baseline, nonphakic eyes had a substantially higher risk for developing either late-stage ARM lesion compared with phakic eyes, OR = 5.7 (95% CI, 2.4–13.6).

Conclusions

Pooled findings from these two large population-based cohorts support the hypothesis that cataract surgery in older persons may be associated with an increased subsequent risk for developing late-stage ARM, particularly neovascular ARM.

Section snippets

Methods

Both the BDES and the BMES are population-based cohort studies of vision and common eye diseases in older, predominantly white populations. The baseline survey methods and procedures of these two cohort studies have been previously described.6, 10, 31, 32 Signed informed consent was obtained from all participants in each study.

The BDES, conducted from 1988 to 1990 in Beaver Dam, Wisconsin, examined 4926 of 5924 eligible residents aged 43 to 86 years (83.1% response). At the time of 5-year

Results

The combined cohort from the two studies consisted of 6019 persons (3684 from the BDES and 2335 from the BMES), including 3435 women and 2584 men. Table 1 shows that the age and gender distributions of the two samples were similar.

After excluding 100 eyes with either late-stage ARM lesion at baseline (67 eyes from the BDES and 33 eyes from the BMES) and eyes with missing or ungradable photographs at either examination, 11,393 eyes (5673 right, 5720 left) were considered at risk for the

Discussion

This analysis includes pooled data from two large population-based cohorts that employed similar diagnostic criteria and study methods. Our findings suggest that the 5-year risk for development of late-stage ARM in the operated eyes of older persons after cataract surgery may be two to five times the risk observed in phakic subjects with similar age, gender, and smoking characteristics. Almost all eyes that developed late-stage ARM during the 5-year period had some early-stage ARM lesions at

References (45)

  • A. Pollack et al.

    Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation

    Ophthalmology

    (1996)
  • W.R. Hawkins

    AMD after ECCE with IOL implant

    Ophthalmology

    (1997)
  • R. Klein et al.

    The Beaver Dam Eye Studyvisual acuity

    Ophthalmology

    (1991)
  • R. Klein et al.

    The Wisconsin age-related maculopathy grading system

    Ophthalmology

    (1991)
  • R. Klein et al.

    The five-year incidence and progression of age-related maculopathythe Beaver Dam Eye Study

    Ophthalmology

    (1997)
  • P. Mitchell et al.

    Five-year incidence of age-related maculopathy lesionsthe Blue Mountains Eye Study

    Ophthalmology

    (2002)
  • B.E. Klein et al.

    Assessment of cataracts from photographs in the Beaver Dam Eye Study

    Ophthalmology

    (1990)
  • M.G. Edwards et al.

    Outcome of cataract operations performed to permit diagnosis, to determine eligibility for laser therapy, or to perform laser therapy of retinal disorders

    Am J Ophthalmol

    (1994)
  • B.E. Klein et al.

    Incident cataract surgerythe Beaver Dam eye study

    Ophthalmology

    (1997)
  • J.J. Wang et al.

    Bilateral involvement by age related maculopathy lesions in a population

    Br J Ophthalmol

    (1998)
  • C.C. Klaver et al.

    Age-specific prevalence and causes of blindness and visual impairment in an older population. The Rotterdam Study

    Arch Ophthalmol

    (1998)
  • J.C. Javitt et al.

    Blindness due to cataractepidemiology and prevention

    Ann Rev Public Health

    (1996)
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    Manuscript no. 220409.

    Supported by the National Institutes of Health (grant EY06594), the Australian National Health & Medical Research Council, Canberra (grants 974159 and 211069), and the Ophthalmic Research Institute of Australia.

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