AMD with Cataract

My mom has recently been diagnosed with macular degeneration and also has a cataract. She knew she would eventually have to have the cataract removed if it progressed to a ripe state. Now that she has been diagnosed with mac. deg. wet and dry, can she still have the cataract removed some day if needed? I cannot remember if the cataract is in the wet or dry eye but does that matter?

Answer:

Because macular degeneration and cataracts both occur in the same age group, it is common to see situations such as your mother's, and people often want to know if cataract surgery will convert dry macular degeneration into wet macular degeneration or make wet macular degeneration accelerate. Many studies have been done looking at this issue, and there have been some conflicting results, but the balance seems to tip toward the conclusion that cataract surgery can predispose an eye to wet macular degeneration and to progression of macular degeneration. To cite one good study (the Beaver Dam Study, named after a town where the study was done), eyes with cataract surgery at baseline had a higher risk of wet macular degeneration over 5 years of followup compared to eyes without cataract surgery. After 5 years, approximately 0.7% of the eyes without cataract surgery had advanced macular degeneration, but approximately 6% of the eyes with cataract surgery at baseline had progressed to advanced macular degeneration. I generally recommend that a patient with both cataract and macular degeneration run the idea of contemplated cataract surgery by the patient's retina specialist. The retina specialist will be more attuned to subtleties of wet macular degeneration, and will be able to stabilize these before the cataract surgeon proceeds. Patients with completely dry macular degeneration have less risk of a perioperative drop in vision from macular degeneration than patients with active, wet macular degeneration. The retina specialist can also probably better gauge what percent of visual loss arises from the macular degeneration versus the percent arising from the cataract. Patients frequently have unrealistically rosy expectations about the outcome of cataract surgery when they also have macular degeneration. The retina specialist can temper these and better align expectations with reality. It is certainly possible for a patient with macular degeneration to benefit from cataract surgery, but the preoperative estimation of benefit is trickier. I hope this helps you understand your mother's situation.