Abstract
AIMS—To determine whether patients with age related macular degeneration (ARMD) benefit from cataract surgery in terms of visual function and quality of life measures, and to assess the impact of surgery on the progression of ARMD. METHODS—A prospective study was carried out of patients with and without ARMD undergoing cataract surgery. Data were collected from 187 patients at the Princess Alexandra Eye Pavilion, Edinburgh and the Oxford Eye Hospital, Oxford. The patients were divided into three groups: (1) a control group with ARMD and no surgery (n=41), (2) a study group of patients with ARMD who underwent cataract surgery (n=90), and (3) a second control group of patients without ocular comorbidities who underwent cataract surgery (n=56). Visual function and quality of life assessments were carried out at baseline and 3-5 months after baseline or surgery. RESULTS—There were significant improvements both in terms of quality of life and visual function measures in the study group. Benefits were greater in patients with moderate cataract irrespective of the degree of ARMD. No increased incidence in progression to the "wet" form of ARMD was found. Improvements in quality of life measures and visual function were more pronounced in patients with no ocular comorbidities. CONCLUSIONS—Patients with mild and moderate degrees of ARMD do benefit from cataract surgery and the benefits are greater in patients with moderate degrees of lens opacity. Longer follow up is required to assess the risk of increased ARMD progression.
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- Alexander M. F., Maguire M. G., Lietman T. M., Snyder J. R., Elman M. J., Fine S. L. Assessment of visual function in patients with age-related macular degeneration and low visual acuity. Arch Ophthalmol. 1988 Nov;106(11):1543–1547. doi: 10.1001/archopht.1988.01060140711040. [DOI] [PubMed] [Google Scholar]
- Arden G. B. The importance of measuring contrast sensitivity in cases of visual disturbance. Br J Ophthalmol. 1978 Apr;62(4):198–209. doi: 10.1136/bjo.62.4.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
- Bird A. C., Bressler N. M., Bressler S. B., Chisholm I. H., Coscas G., Davis M. D., de Jong P. T., Klaver C. C., Klein B. E., Klein R. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol. 1995 Mar-Apr;39(5):367–374. doi: 10.1016/s0039-6257(05)80092-x. [DOI] [PubMed] [Google Scholar]
- Brazier J. E., Harper R., Jones N. M., O'Cathain A., Thomas K. J., Usherwood T., Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160–164. doi: 10.1136/bmj.305.6846.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cassard S. D., Patrick D. L., Damiano A. M., Legro M. W., Tielsch J. M., Diener-West M., Schein O. D., Javitt J. C., Bass E. B., Steinberg E. P. Reproducibility and responsiveness of the VF-14. An index of functional impairment in patients with cataracts. Arch Ophthalmol. 1995 Dec;113(12):1508–1513. doi: 10.1001/archopht.1995.01100120038005. [DOI] [PubMed] [Google Scholar]
- Desai P., Minassian D. C., Reidy A. National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol. 1999 Dec;83(12):1336–1340. doi: 10.1136/bjo.83.12.1336. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Desai P., Reidy A., Minassian D. C., Vafidis G., Bolger J. Gains from cataract surgery: visual function and quality of life. Br J Ophthalmol. 1996 Oct;80(10):868–873. doi: 10.1136/bjo.80.10.868. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hart P. M., Chakravarthy U., Stevenson M. R., Jamison J. Q. A vision specific functional index for use in patients with age related macular degeneration. Br J Ophthalmol. 1999 Oct;83(10):1115–1120. doi: 10.1136/bjo.83.10.1115. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kleiner R. C., Enger C., Alexander M. F., Fine S. L. Contrast sensitivity in age-related macular degeneration. Arch Ophthalmol. 1988 Jan;106(1):55–57. doi: 10.1001/archopht.1988.01060130061028. [DOI] [PubMed] [Google Scholar]
- Lundström M., Stenevi U., Thorburn W. Outcome of cataract surgery considering the preoperative situation: a study of possible predictors of the functional outcome. Br J Ophthalmol. 1999 Nov;83(11):1272–1276. doi: 10.1136/bjo.83.11.1272. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lyons R. A., Perry H. M., Littlepage B. N. Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population. Age Ageing. 1994 May;23(3):182–184. doi: 10.1093/ageing/23.3.182. [DOI] [PubMed] [Google Scholar]
- Mangione C. M., Berry S., Spritzer K., Janz N. K., Klein R., Owsley C., Lee P. P. Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: results from focus groups with visually impaired persons. Arch Ophthalmol. 1998 Feb;116(2):227–233. doi: 10.1001/archopht.116.2.227. [DOI] [PubMed] [Google Scholar]
- Mangione C. M., Phillips R. S., Seddon J. M., Lawrence M. G., Cook E. F., Dailey R., Goldman L. Development of the 'Activities of Daily Vision Scale'. A measure of visual functional status. Med Care. 1992 Dec;30(12):1111–1126. doi: 10.1097/00005650-199212000-00004. [DOI] [PubMed] [Google Scholar]
- Midena E., Degli Angeli C., Blarzino M. C., Valenti M., Segato T. Macular function impairment in eyes with early age-related macular degeneration. Invest Ophthalmol Vis Sci. 1997 Feb;38(2):469–477. [PubMed] [Google Scholar]
- Miller S. T., Graney M. J., Elam J. T., Applegate W. B., Freeman J. M. Predictions of outcomes from cataract surgery in elderly persons. Ophthalmology. 1988 Aug;95(8):1125–1129. doi: 10.1016/s0161-6420(88)33049-6. [DOI] [PubMed] [Google Scholar]
- Patrick D. L., Deyo R. A. Generic and disease-specific measures in assessing health status and quality of life. Med Care. 1989 Mar;27(3 Suppl):S217–S232. doi: 10.1097/00005650-198903001-00018. [DOI] [PubMed] [Google Scholar]
- Pollack A., Bukelman A., Zalish M., Leiba H., Oliver M. The course of age-related macular degeneration following bilateral cataract surgery. Ophthalmic Surg Lasers. 1998 Apr;29(4):286–294. [PubMed] [Google Scholar]
- Pollack A., Marcovich A., Bukelman A., Oliver M. Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation. Ophthalmology. 1996 Oct;103(10):1546–1554. doi: 10.1016/s0161-6420(96)30464-8. [DOI] [PubMed] [Google Scholar]
- Sarks J. P., Sarks S. H., Killingsworth M. C. Evolution of geographic atrophy of the retinal pigment epithelium. Eye (Lond) 1988;2(Pt 5):552–577. doi: 10.1038/eye.1988.106. [DOI] [PubMed] [Google Scholar]
- Sarks J. P., Sarks S. H., Killingsworth M. C. Evolution of soft drusen in age-related macular degeneration. Eye (Lond) 1994;8(Pt 3):269–283. doi: 10.1038/eye.1994.57. [DOI] [PubMed] [Google Scholar]
- Schein O. D., Steinberg E. P., Cassard S. D., Tielsch J. M., Javitt J. C., Sommer A. Predictors of outcome in patients who underwent cataract surgery. Ophthalmology. 1995 May;102(5):817–823. doi: 10.1016/s0161-6420(95)30952-9. [DOI] [PubMed] [Google Scholar]
- Shuttleworth G. N., Luhishi E. A., Harrad R. A. Do patients with age related maculopathy and cataract benefit from cataract surgery? Br J Ophthalmol. 1998 Jun;82(6):611–616. doi: 10.1136/bjo.82.6.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sjöstrand J., Frisén L. Contrast sensitivity in macular disease. A preliminary report. Acta Ophthalmol (Copenh) 1977 Jun;55(3):507–514. doi: 10.1111/j.1755-3768.1977.tb06128.x. [DOI] [PubMed] [Google Scholar]
- Sparrow J. M., Bron A. J., Brown N. A., Ayliffe W., Hill A. R. The Oxford Clinical Cataract Classification and Grading System. Int Ophthalmol. 1986 Dec;9(4):207–225. doi: 10.1007/BF00137534. [DOI] [PubMed] [Google Scholar]
- Steinberg E. P., Tielsch J. M., Schein O. D., Javitt J. C., Sharkey P., Cassard S. D., Legro M. W., Diener-West M., Bass E. B., Damiano A. M. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol. 1994 May;112(5):630–638. doi: 10.1001/archopht.1994.01090170074026. [DOI] [PubMed] [Google Scholar]
- Sunness J. S., Massof R. W., Johnson M. A., Finkelstein D., Fine S. L. Peripheral retinal function in age-related macular degeneration. Arch Ophthalmol. 1985 Jun;103(6):811–816. doi: 10.1001/archopht.1985.01050060071029. [DOI] [PubMed] [Google Scholar]
- Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
- van der Schaft T. L., Mooy C. M., de Bruijn W. C., Mulder P. G., Pameyer J. H., de Jong P. T. Increased prevalence of disciform macular degeneration after cataract extraction with implantation of an intraocular lens. Br J Ophthalmol. 1994 Jun;78(6):441–445. doi: 10.1136/bjo.78.6.441. [DOI] [PMC free article] [PubMed] [Google Scholar]