title: Risk of age-related macular degeneration 3 years after cataract surgery: paired eye comparisons.
abstract: OBJECTIVE
  To clarify possible associations between cataract surgery and progression of age-related macular degeneration (AMD).
  
  
  METHODS
  Clinic-based cohort.
  
  
  METHODS
  We followed cataract surgical patients aged 65+ years in the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study. Patients who remained unilaterally phakic for at least 24 months after recruitment were included.
  
  
  METHODS
  We performed annual examinations with retinal photography. We assessed AMD using side-by-side grading of images from all visits. Paired comparisons between operated and nonoperated fellow eyes (defined as nonoperated or operated <12 months previously) were made using generalized estimating equation models.
  
  
  METHODS
  Incident early AMD was defined as the new appearance of soft indistinct/reticular drusen or coexisting retinal pigmentary abnormality and soft distinct drusen in eyes at risk of early AMD. Incident late AMD was defined as the new appearance of neovascular AMD or geographic atrophy (GA) in eyes at risk of late AMD.
  
  
  RESULTS
  Among 2029 recruited, eligible participants, 1851 had cataract surgery performed at Westmead Hospital, Sydney, and 1244 (70.7%) had 36-month postoperative visits. Of these participants, 1178 had gradable photographs at baseline and at least 1 follow-up visit. Of 308 unilaterally operated participants at risk of late AMD, this developed in 4 (1.3%) operated and 7 (2.3%) nonoperated fellow eyes (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.23-2.36) after adjusting for the presence of early AMD at baseline. Of 217 unilaterally operated participants at risk of early AMD, this developed in 23 (10.6%) operated and 21 (9.7%) nonoperated fellow eyes (OR, 1.07; 95% CI, 0.74-1.65). Incident retinal pigment abnormalities were more frequent in operated than nonoperated fellow eyes (15.3% vs. 9.9%; OR, 1.64; 95% CI, 1.07-2.52). There was no difference in the 3-year incidence of large soft indistinct or reticular drusen between the 2 eyes (8.8% vs. 7.9%; OR, 1.12; 95% CI, 0.79-1.60).
  
  
  CONCLUSIONS
  Prospective follow-up data and paired eye comparisons of this older surgical cohort showed no increased risk of developing late AMD, early AMD, or soft/reticular drusen over 3 years. There was a 60% increased detection of retinal pigmentary changes in surgical eyes.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia. jiejin.wang@sydney.edu.au
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Calvin Sze-Un
authors.initials: CS
authors.lastname: Fong
authors.forename: Elena
authors.initials: E
authors.lastname: Rochtchina
authors.forename: Sudha
authors.initials: S
authors.lastname: Cugati
authors.forename: Tania
authors.initials: T
authors.lastname: de Loryn
authors.forename: Shweta
authors.initials: S
authors.lastname: Kaushik
authors.forename: Jennifer S L
authors.initials: JS
authors.lastname: Tan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Arnold
authors.forename: Wayne
authors.initials: W
authors.lastname: Smith
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000453:epidemiology; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D057092:Geographic Atrophy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010781:Photography; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology