Cataracts and macular degeneration (MD) are common age-related eye conditions that frequently occur together. This article clarifies the considerations and safety of undergoing cataract surgery when also living with macular degeneration, helping individuals make informed decisions about their eye health.
Understanding Cataracts and Macular Degeneration
Cataracts involve a clouding of the eye’s natural lens, which focuses light onto the retina. This clouding can make vision appear blurry, hazy, or less colorful, similar to looking through a fogged-up window. Age-related cataracts are the most common type, often developing gradually.
Macular degeneration (MD), also known as age-related macular degeneration (AMD), affects the macula, a small central portion of the retina responsible for sharp, detailed central vision. AMD leads to blurred or distorted central vision, impacting activities like reading or recognizing faces, while peripheral vision usually remains unaffected. There are two primary types: dry AMD, which involves the formation of tiny yellow protein deposits called drusen and gradual thinning of the macula, and wet AMD, characterized by abnormal blood vessel growth under the retina that can leak fluid and blood.
Weighing Safety and Potential Outcomes
For many individuals with both cataracts and macular degeneration, cataract surgery can be a beneficial option. An ophthalmologist carefully assesses several factors before recommending surgery, including the type and severity of macular degeneration, overall eye health, and the patient’s visual goals. This assessment helps determine how much vision loss is due to the cataract versus the macular degeneration.
Cataract surgery is generally considered safe for those with dry AMD. Current research suggests it does not worsen the condition or its progression.
For individuals with wet AMD, specific considerations apply. Your eye doctor might recommend stabilizing wet AMD, possibly with anti-VEGF injections, before proceeding with cataract surgery. While some experts suggest a potential for inflammation from surgery to worsen wet AMD, evidence is less consistent.
Cataract removal can improve vision by allowing more light to reach the retina, reducing glare, and enhancing brightness and color perception. However, while a clear lens is restored, the underlying damage to the macula from MD will still limit ultimate visual acuity. The surgery aims to improve vision to the extent possible given the MD, or to improve quality of life by reducing symptoms like blur and glare.
The Surgical Procedure and Recovery
Cataract surgery is commonly performed using phacoemulsification. This outpatient procedure typically takes less than an hour. A surgeon makes a small incision, uses ultrasound to break up the clouded lens, and suctions out the fragments. A clear artificial lens (intraocular lens or IOL) is then implanted.
Patients usually return home the same day. Vision may be blurry initially, with gradual improvement over the following days and weeks. Post-operative care includes using prescribed eye drops to prevent infection and reduce inflammation.
Common post-operative instructions involve avoiding rubbing or pressing on the eye, and wearing an eye shield, especially during sleep, for about a week. Patients are advised to refrain from strenuous activities, heavy lifting, and bending at the waist for one to two weeks to avoid increasing eye pressure. Keeping the eye clean and dry is also important; patients should avoid getting water directly into the eye and abstain from swimming or hot tubs for a few weeks to minimize infection risk.
Realistic Visual Expectations
While cataract surgery can significantly improve vision by removing the cloudy lens, the degree of improvement will be influenced by the severity of the macular degeneration. The surgery will not cure or stop the progression of MD, as it addresses the lens and not the retina. Even after cataract removal, central vision impairment due to MD may persist, meaning reading or recognizing faces might still be challenging.
Patients can anticipate improvements in brightness, color perception, and peripheral vision. For those with significant cataracts, the removal can lead to a noticeable enhancement in overall visual clarity and quality of life. However, if the macular degeneration is advanced, the visual improvement from cataract surgery might be limited.
Ongoing management for macular degeneration remains important even after cataract surgery. Regular follow-up appointments with an ophthalmologist are necessary to monitor the MD and address any changes.