New Data on the Reported Link between Cataract Surgey and AMD

1. New Data on the Reported Link between Cataract Surgey and AMD Wang JJ, Mitchell P, et al. Risk of age-related macular degeneration 3 years after cataract surgery: Paired eye comparisons. Ophthalmology 119(11): 2298-2303, 2112 Paul MitchellMD PhD FRANZCO University of Sydney Department of Ophthalmology

2. Blue Mountains Eye Study cases baseline after 5 years after 10 years

3. AMD and Cataract Surgery • Cataract is the major cause of visual impairment in older persons; AMD is principal cause of blindness • Cataract surgery -most frequently performed operation in many countries; arguably the most successful • No association found between AMD and cataract in population-based studies • Series of case reports suggested a link between cataract surgery and progression to NV-AMD

4. Cataract Surgery and AMD • Pooled findings 2 population cohorts (BDES, BMES) suggested cataract surgery may be associated with substantially higher risk of late AMD • Risk of developing AMD in eyes already operated at baseline 3-5 times than in phakic eyes of persons with similar age, gender, smoking, early ARM signs • odds ratio 4.9 (1.9-12.4) for NV AMD • odds ratio 4.5 (1.4-14.7) for GA • Risk appears longer-term • Important implications; studies of mechanisms needed Wang, et al Ophthalmology 2003, GEE analysis

5. Recent Data: Ophthalmol Nov 2012 Wang et al • We followed consecutive cataract surgical patients recruited at Westmead Hospital in Sydney, Australia into the Cataract Surgery & Age-related Macular Degeneration (CSAMD) Study – 2029 eligible participants • Incident early AMD defined as: new appearance of soft indistinct drusen or co-existing retinal pigmentary changes and soft distinct drusen in eyes at risk of early AMD. Incident late AMD defined as: new appearance of neovascular AMD or geographic atrophy (GA) in eyes at risk of late AMD • 1851/ 2029 pts had surgery; 70.4% had 3-year post-op visits • Of 308 who had unilateral cataract surgery at risk of late AMD, this developed in 4 (1.3%) & 7 (2.3%) non-operated fellow eyes, odds ratio (OR) 0.74, CI 0.74-1.65), adjusting for presence of early AMD at baseline • Of 217 who had unilateral cataract surgery at risk of early AMD, this developed in 23 (10.6%) & 21 (9.7%) non-operated fellow eyes (OR 1.07, CI 0.74-1.65)

6. Recent Data: Ophthalmol Nov 2012 Wang et al • Incident RPE abnormalities were more frequent in operated than non-operated fellow eyes (15.9% vs 9.9%, OR 1.64, CI 1.07-2.52) • There was no difference in 3-year incidence of large soft indistinct or reticular drusen between the 2 eyes (8.8% vs 7.9%, OR 1.12, CI 0.79-1.60) • Prospective follow-up data & paired eye comparisons of this surgical cohort showed no increased 3-Y risk of developing late AMD/ early AMD signs. There was a 60% increased detection of RPE changes in surgical eyes • Distribution of early AMD lesions was more frequent among persons undergoing cataract surgery than among age peers in the older population • This study provides a partial explanation for the inconsistent observations on possible links between cataract surgery & AMD from population vs clinic-based studies

7. Conclusions • Incid