What is macular degeneration, and how does it affect vision?

Macular degeneration, particularly age-related macular degeneration (AMD), affects the macula, the central part of the retina responsible for detailed vision. It leads to central vision loss while often sparing peripheral vision. Cataracts cloud the eye’s lens and can compound visual impairment when both conditions coexist.

Is cataract surgery suitable for patients with macular degeneration?

Yes, but it depends on the severity of macular degeneration:

• Dry AMD: Cataract surgery is generally safe and may improve vision depending on macular health.
• Wet AMD: Surgery requires stabilisation of active choroidal neovascularisation (CNV) with anti-VEGF therapy before proceeding.

What evaluations are needed before surgery?

A comprehensive preoperative assessment, which includes optical coherence tomography (OCT), is crucial. This assessment helps us evaluate the health of your macula, ensuring that your expectations are realistic. While surgery cannot restore vision already lost to AMD, it can significantly improve the overall quality and functionality of your vision.

What are the benefits of cataract surgery in AMD patients?

• Reduced Blurriness: Surgery removes the cloudy lens, improving peripheral vision and reducing glare.
• Improved Quality of Life: Better light perception and contrast sensitivity can aid daily activities.
• Enhanced Use of Low Vision Aids: Clearer vision may improve the effectiveness of visual aids.

What surgical techniques are used?

The preferred method is phacoemulsification with intraocular lens (IOL) implantation.

• Monofocal IOLs are recommended for their predictability.
• Multifocal or accommodating IOLs are generally avoided due to reliance on macular function.
• Blue-light filtering IOLs may reduce macular stress, but evidence for AMD-specific benefits is mixed.

Are there risks or challenges?

• Progression of AMD: Cataract surgery does not directly worsen AMD; postoperative inflammation may reveal hidden macular abnormalities.
• Surgical Risks: In AMD patients, complications like posterior capsule opacification (PCO) or cystoid macular oedema (CME) are slightly higher.
• Limited Gains in Advanced AMD: Vision improvement may be minimal in severe cases.

What postoperative care is needed?

• Continued Anti-VEGF Therapy: For wet AMD, injections may continue post-surgery.
• Low Vision Rehabilitation: Specialist referral can help optimise residual vision.
• Regular Monitoring: Follow-ups are essential to track macular health and address complications.

What can patients expect after surgery?

Patients should understand that cataract surgery will not reverse AMD damage but can improve functional vision. Functional vision refers to the ability to perform daily tasks, such as reading, cooking, or driving, with less difficulty. The surgery can also reduce glare, contributing to an improved quality of life. Managing expectations and providing tailored care are key to success.