Surgery for cataracts in people with age-related macular degeneration

Cataract and age-related macular degeneration (AMD) are significant causes of decreased vision in the elderly that often occur simultaneously. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of progression of underlying AMD and thus have deleterious effects on vision.

The objective of this review was to evaluate the effectiveness and safety of cataract surgery in eyes with AMD.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2008), MEDLINE (January 1966 to November 2008), EMBASE (January 1980 to November 2008) and Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to November 2008). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 4 November 2008.

We planned to include randomized controlled trials (RCTs) and quasi-randomized trials of eyes affected by both cataract and AMD in which cataract surgery would be compared to no surgery.

Two authors independently evaluated the search results against the inclusion and exclusion criteria. Discrepancies were resolved by discussion.

We found no RCTs, thus no analysis was conducted. Evidence was limited to non-randomized clinical trials and prospective cohort and case-control studies.

At this time, it is not possible to draw reliable conclusions from the available data to determine whether cataract surgery is beneficial or harmful in people with AMD. Physicians will have to make practice decisions based on best clinical judgement until controlled trials are conducted and their findings published.