A national ophthalmology registry study of 80,000 propensity-matched eyes found that patients with dry age-related macular degeneration (dAMD) who underwent cataract surgery had a small but statistically significant higher risk of converting to neovascular (wet) AMD. The hazard ratio was 1.22 compared with those who did not have surgery, according to results published in Ophthalmology.
The risk was strongest in the first year after surgery (HR 2.5) and then declined steadily, becoming non-significant after four years. By six years, the cumulative incidence of wet AMD was 17.7% in the surgery group versus 15.2% in the control group—an absolute difference of less than 3%. The authors noted that the early spike may be driven by patients whose vision loss was incorrectly attributed to cataract, with postoperative surveillance unmasking pre-existing or incipient disease.
An invited commentary by Emily Y. Chew and colleagues at the National Eye Institute called the association “rather small” and likely explained by increased surveillance after surgery. They emphasized that patients with AMD and cataract should be informed of the potential risk, but that the key message is to ensure vigilant and meticulous follow-up after surgery, because good treatments exist for neovascular AMD. The study does not establish a causal relationship, and prior research on this question has been mixed.