Long-term visual outcome after cataract surgery: Comparison of healthy eyes and eyes with age-related macular degeneration

PURPOSE: To compare the long-term longitudinal visual acuity outcomes after cataract surgery in eyes with age-related macular degeneration (AMD) at surgery and eyes without comorbidity. SETTING: University-based eye clinic. DESIGN: Longitudinal cohort study. METHODS: Patients having cataract surgery were evaluated over 1 year. A clinical eye examination and corrected distance visual acuity (CDVA) measurement were performed preoperatively and postoperatively as well as 5 and 10 years postoperatively for eligible patients. The patients were divided into functional groups depending on postoperative signs of macular degeneration and postoperative CDVA. RESULTS: The study evaluated 810 patients. The rate of CDVA decline with age was faster in AMD patients than in patients without comorbidity. The slope of the visual acuity decline was similar in the 2 subgroups with AMD (almost normal CDVA and reduced CDVA postoperatively). After adjustment for age, there was a mean loss of 2.3 logMAR letters in patients with no comorbidity and 6.4 letters in patients with AMD at surgery for each decade of increasing age. More than 75% of AMD patients had better CDVA 10 years after surgery than before surgery. CONCLUSIONS: Patients with signs of AMD at cataract surgery had a longitudinally worse visual outcome than patients without clinical signs of AMD. However, there is no reason to discourage patients with concurrent visually significant cataract and AMD from having surgery because most AMD patients had better CDVA 10 years after surgery than before surgery.