Does Cataract Surgery Cause Macular Degeneration?

Does Cataract Surgery Cause Macular Degeneration?  Randall Wong, M.D., Ophthalmologist, Fairfax, VirginiaCataract surgery does not cause macular degeneration.  Macular degeneration, however, is often discovered just after cataract surgery when the vision fails to improve as hoped, causing many patients (and their frustrated families) to wonder if the cataract surgery caused macular degeneration.

Failure for Vision to Improve

In most cases of cataract surgery, vision gets better just after the surgery is completed.  In the normal circumstance,  surgery improves the vision quickly within  a day or two.

Patients who fail to improve may be referred to a retina specialist for further evaluation.

Cataracts and ARMD

Both eye diseases become more common as we get older.   Most of the time, it’s easy to distinguish between cataracts, macular degeneration or some other cause of visual loss.

Sometimes we can’t diagnose AMD because we can’t examine the retina.

When patients are referred for cataract evaluation, we do our best to ensure the cataract is indeed the cause of vision problem.  In other words, can the degree of cataract cause all of the patients symptoms?  A dilated eye exam is performed.

If there is an inconsistency, say when there is vision loss, but not much cataract (remember, cataract is clouding of the natural lens of the eye) then other causes of the visual loss must be considered, such as retinal disease, glaucoma, etc.

At times, however, the cataract is pretty dense (cloudy) making direct examination of the retina very difficult.  Just as the patient is unable to see “out” of the eye, we are unable to see “in.”

Disappointing Results

When cataract surgery is performed, but the vision does not improve, everyone is disappointed…the patient, the family and the doctor.  From our end, it is very difficult to explain that something else, for example, macular degeneration, is really causing the problem.

Not surprising, patients start to question if cataract surgery causes macular degeneration.

What Does This Mean?

Ideally, patients with dense cataracts and/or severe vision loss might benefit from an evaluation with a retina specialist.  This “objective” evaluation might avoid some of the disappointment and frustration that results from a “surprise” diagnosis of macular degeneration.

In the end, every one would benefit, because surprises and disappointment erodes…trust.

 



Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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Comments

  1. Rick Anderson, Ph. D. says:

    Dr. Randy Wong gives VERY professional info and exams.

    In fact, after 15 years of being diagonosed with Macular Degeneration. he was immediately able to tell me I didn’t have it!

    The key word is “retinal specialist” – I had been consulting only with opthamologists.

    Needless to say, it was quite a relief after a decade and more of worry!

  2. Darlene Ayres says:

    There is now hope for those with macular degeneration. The Implantable Miniature Telescope, referred to as the IMT, by Dr. Isaac Lipshitz, is now approved by the FDA and Medicare. Medicare pays the $15,000 for the device and your standard co-pays apply for visits with the eye specialists. At this time, candidates must be over 75 years old, have been declared “legally blind”, and must not have had cataract surgery in the eye that the implant will be placed in. I have done a lot of research on this (on behalf of my dad). Contact CentraSight at 877-99-SIGHT or go to http://www.centrasight/com for more information. There is hope! They are currently trying to get FDA approval to perform this procedure on those that have had cataract surgery in both eyes.

    I hope this information helps those who are struggling with macular degeneration.

  3. Michele Nelson says:

    May cataract surgery improve vision in patients with dry AMD, or is it performed just so the ophtalmologist can see the state of the retina?

  4. Dear Dr. Rick,

    Thanks for your kind words. Hope you are well.

    Thanks for contributing!

    Randy

  5. Dear Darlene,

    Thank you for sharing all this information. It is helpful to others….I hope the device becomes available soon.

    Randy

  6. Dear Michele,

    Either can happen. If the decreased vision is due to two causes; cataract and macular degeneration, then cataract surgery may improve the vision to the limits of the macular disease.

    Sometimes, too, the cataract is so dense (bad) that we physicians can not see inside the eye to examine the retina. So, sometimes there is a medical necessity to perform cataract surgery…it facilitates better examination.

    Randy

  7. Shelley Trope-Friedman says:

    Dear Dr. Wong,
    Thank you for your website and most informative details about this awful disease.
    I live in Cape Town South Africa.
    We have good ophthalmologists here but it appears that at the moment there is no cure or assistance with ARMD.

    I am 60 years old. I went to have a cataract in my left eyed removed but decided not to do it when the doctor advised me that he could see about 25 Drusen in my right eye in which had performed a cataract and lens replacement about four years ago.
    The left eye seems to be in need of a cataract now but when he told me about the right eye I decided to delay surgery as the left eye has only two or three Drusen and I was concerned about cataract surgery exacerbating the start of ARMD although he assured me that the two were not related and that I need not worry.
    I have read a lot about it and have seen that blue light could be responsible and that cataract replacement could be responsible for blue light entering the eye.
    My late father and his late sister both had macular degeneration and I am blonde with blue eyes and Caucasian so have a very good chance of it developing in the future if not now. I have some photos that he took but they were without dilation so maybe they are not as accurate as they could be.

    At the same time he examined my husband who is 77years old and he told him that he has ARMD in his right eye and that there is nothing he can do as even vitamins at his stage would not work. This was a shock as Alex has always had brilliant vision and this must have developed over the last year only.

    Therefore we both need some advice and help from you as follows:

    Is there anything I can do to prevent further development? Is cataract surgery considered safe and should I have further examination of the retina before or after cataract surgery?

    Secondly, how does my husband Alex know what to do about protecting his good eye and how does he know whether this is dry AMD or Wet AMD.

    The amsler grid has straight lines in my case but wavy lines in the case of his right eye with AMD.

    This all happened in the last week and we are both in a state of shock and surprise.
    I have read quite detailed reports about AMD and to me there seems to be no answer whatsoever.
    I would however appreciate your advice and recommendations. We may consider coming to the States if you feel that it would be worthwhile.

    Stem cells or microscope insertion seem to be the only answer.

    Many Thanks,
    Shelley Trope- Friedman.

  8. Dear Shelley,

    I am not aware of any evidence that cataract surgery promotes progression of ARMD.

    I think most modern IOL’s filter both UV and Blue Light. Check with your doc.

    Just because you have drusen in the right eye (or either eye) does not mean you have ARMD. There can be other causes of distortion, such as an ERM.

    Your questions:

    1. Nothing proven to prevent further development.
    2. In my opinion, cataract surgery is very safe for you.
    3. A retina specialist should be able to determine the cause of the distortion/wavy lines and determine if Alex has ARMD or not.

    Thanks!

    Randy

  9. Randy – My right eye has retinal detachment. I was all set to go into surgery when it was cancelled at the anesthesiologists request. I have among other things, asthma, emphysema, COPD, epilepsy, a heart condition and a herniated diaphragm (my stomach is above the diaphragm by quite a bit). My meds consist of approximately 25 to 30 different medications daily. I have been turned down for surgery by two different surgeons. One was for incontinence and the other for the herniated diaphragm. They both felt that I would not make it through surgery. I did have cataract surgery on both eyes a year ago. It went beautifully.
    Now this opthamologist wants to fix my detached retina with general anesthetic. My cardiologist is not available for another two months (out of the country) so I saw another one two days ago. I don’t really have a pulmonologist so am seeing one that I don’t know on the day after Thanksgiving. The cardiologist said “go ahead”. I’m not sure what the pulmonologist will say. I would expect him to say no to the anesthetic. The opthamologist really wants to do it; but there are so many risk facters in my case. I am 69 yrs. old and am surprised to have lived this long as, in the past, two gp’s have told me (once around age 40/the other in my 50′s) that I was dying. I wonder just how many lives can one person have? Our 50th anniversary is 8 mos from now and it is my goal to live that long if possible. I am about ready to let this right eye go blind and take my chances with the left one.
    One big question I have is: The opthamologist makes it sound like if I don’t have the surgery, the other eye will follow almost immediately; yet I can’t understand why and he doesn’t explain. He has never examined the left eye – only the right. Can you try to put this into some sort of perspective for me?
    I feel as though it is a case of dying with possibly good eyes or living blind. The loss of one eye would not bother me so much. I should mention that the condition is not one of heredity but rather from a very hard fall a few months back where I hit my head very hard. It actually still hurts just a little. Please get back to me as soon as possible because he has the surgery scheduled for a week from tomorrow. Sincerely…….Barb

  10. Barb,

    You’ve had surgery by now?

    Certainly, there is no correlation with one eye getting a detachment and going blind and its influence on the other eye.

    I hope you are well.

    r

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