EyeWorld Asia-Pacific September 2019 Issue

EWAP SEPTEMBER 2019 39 CATARACT undergoing wet AMD treatment after routine cataract surgery, with special attention to the use of blue blocking IOLs. "v Ìi £Óä]äÎ wÀÃÌ iÞi surgeries with preoperative AMD >` {xÓ]ÓÎn wÀÃÌ iÞi ÃÕÀ}iÀiÃ without preoperative AMD that were performed between 1 January 2010 and 1 September 2017, 744 eyes (0.6%) with AMD and 954 eyes (0.2%) without AMD underwent treatment for wet AMD at least 1 year after the cataract procedure. The investigation revealed that female gender was a general risk factor for AMD progression «ćä°ääÓ®] >Ã ÜiÀi `iÀ >}i (p<0.001) and low visual acuity (p=0.006), which were associated with an increased risk but only in eyes without AMD before the cataract procedure. The study data showed that the use of a blue blocking " `` Ì yÕiVi Ìi ÀÃ for undergoing subsequent treatment for wet AMD in eyes without preoperative AMD but appeared to have a slight protective effect in eyes with preoperative AMD (p=0.021). À° i`}½Ã ÛiÃÌ}>Ì Ãi`Ã Ãi }Ì > VyVÌ} issue. Cataract surgery has been implicated in the past for inducing AMD in older patients. One study that assessed the association between cataract surgery (5,913 patients) and the rate of photodynamic therapy (PDT) for AMD (283 patients) within the chronic disease registry of Israel’s largest HMO between Óää£ >` Óääx `iÌwi` > increased rate of PDT 1 to 1.5 years after cataract surgery. 1 Another study suggests that evidence pointing toward the development of neovascular AMD following cataract surgery is largely anecdotal and lacking clinical trials. In the study, the researchers searched several large databases in 2012 for randomized controlled trials that compared cataract surgery to no surgery in eyes with AMD. One randomized VÌÀi` ÌÀ> Ü>Ã `iÌwi` Ì>Ì ÃÜi` Ã}wV>Ì `vviÀiVi between the two groups. 2 Patients with cataract and wet AMD underwent safe cataract surgery, according to a different study in which 81 eyes had cataract surgery and received at least one anti-VEGF injection between 2012 and 2016. This study found the procedures compatible, with no worsening of neovascularization after surgery. 3 *>ÌiÌÃ ÜÌÛÃÕ>Þ Ã}wV>Ì cataract and AMD demonstrated improved visual acuity, absence v Ã}wV>Ì `Ãi>Ãi «À}ÀiÃÃ] and improved quality of life, according to yet another investigation. 4 EWAP Editors’ note: Dr. Behndig practices at the Department of Clinical Sciences/ Ophthalmology, Umea University Hospital, 7OGC 5YGFGP CPF JCU PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU References 1. Kaiserman I, et al. Cataract surgery is associated with a higher rate of photodynamic therapy for age-related macular degeneration. Ophthalmol. ÓääÇÆ££{\ÓÇnqnÓ° 2. Casparis H, et al. Surgery for cataracts in people with age-related macular degeneration. Cochrane Database Syst Rev. Óä£ÓÆ ääÈÇxÇ° 3. Starr MR, et al. Outcomes of cataract surgery in patients with exudative age- related macular degeneration and macular yÕ`° Am J Ophthalmol. Óä£nÆ£Ó\£q Ç° 4. Ehmann DS, Ho AC. Cataract surgery and age-related macular degeneration. Curr Opin Ophthalmol. Óä£ÇÆÓn\xnqÈÓ° M odern day cataract surgery can provide almost immediate improvement in visual acuity and quality of life in patients ÜÌÃ}wV>Ì V>Ì>À>VÌÃ° /i Ã>viÌÞ «Àwi Ã iÝViiÌ° 9iÌ] in certain subgroups of patients with preexisting comorbidities, the question remains as to whether cataract surgery should be deferred. In the case of age-related macular degeneration (AMD), natural history studies have consistently demonstrated that eyes with early AMD are at higher risk of developing neovascular changes compared to eyes without features of early AMD. It has been proposed that ` «ÃÌ« y>>Ì] >Ã Üi >Ã VÀi>Ãi` }Ì iÝ«ÃÕÀi >vÌiÀ cataract surgery may further accelerate progression in these eyes. At the 36th Congress of the European Society of Cataract and Refractive -ÕÀ}iÃ] À° Ƃ`iÀÃ i`} «ÀiÃiÌi` iÜ `>Ì> ÜV>Þ i« ÃÕÀ}iÃ >ÃÃiÃÃ ÌÃ ÃÌÕ>Ì° >Ãi` Ìi -Üi`Ã >Ì> >Ì>À>VÌ ,i}ÃÌÀÞ Óä£äqÓä£Ç®] {xÓ]ÓÎn wÀÃÌ iÞi ÃÕÀ}iÀiÃ ÜÌÕÌ «Ài«iÀ>ÌÛi Ƃ ÜiÀi V«>Ài` ÜÌ£Óä]äÎ wÀÃÌ iÞiÃ ÃÕÀ}iÀiÃ with preoperative AMD. Among patients without preoperative AMD, 954 eyes (0.2%) underwent treatment for wet AMD within 1 year of cataract procedure. A higher incidence of 0.6% was noted in eyes with preoperative AMD. Several key messages can be derived from this study. First, early AMD is highly prevalent in the age group undergoing cataract surgery, accounting for about 21% of this cohort. Thus, adequate preoperative counseling is important. Second, although a higher incidence rate (3-fold increase) of wet AMD was noted in patients with preoperative AMD compared to those without preoperative AMD, the absolute rate remains low at 0.6% within 1 year. This risk should be weighed against Ìi LiiwÌ v ÃÕÀ}iÀÞ > iÞi ÜÌÛÃÕ>Þ Ã}wV>Ì V>Ì>À>VÌ° /À`] even in patients without preoperative AMD, the background rate of wet AMD development estimated at 0.2% should be borne in mind. /Ã Ã ÀiyiVÌÛi v Ìi >}i }ÀÕ« v «>ÌiÌÃ Õ`iÀ}} V>Ì>À>VÌ surgery. Finally, whether cataract surgery itself contributed to the increased incidence of wet AMD could not be concluded from this study design. Overall, these data suggest that patients with preoperative AMD are at higher risk of progression to wet AMD compared to those without preoperative AMD. While this is not surprising, the absolute risk is low and should not be a major factor against surgery if the V>Ì>À>VÌ Ã ÛÃÕ>Þ Ã}wV>Ì° À >>}iiÌ «ÕÀ«ÃiÃ] >««À«À>Ìi preoperative counseling and postoperative vigilance are advisable. ÜiÛiÀ] Ìi «ÀiÃiVi v ÛÃÕ>Þ Ã}wV>Ì V>Ì>À>VÌ] ÌiÃi `>Ì> ÃÕ}}iÃÌ Ìi LiiwÌÃ v ÃÕÀ}iÀÞ iÞ ÕÌÜi}Ìi «ÌiÌ> ÀÃÃ° 'FKVQTUo PQVG &T %JGWPI FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU Gemmy Cheung, MBBS, FRCOphth, FAMS, MCI Head & Senior Consultant, Medical Retina Department Singapore National Eye Centre 11 Third Hospital Avenue, Singapore 168751 Gemmy.cheung.c.m@snec.com.st ASIA-PACIFIC PERSPECTIVES eyes not treated for AMD within the same time period were used as controls. Pre- and perioperative risk v>VÌÀÃ ÜiÀi `iÌwi` >} with protective factors for