Expectations need to be managed in combined cataract-AMD patients

Age-related macular degeneration (AMD) and cataracts both progress with age, with the current body of evidence indicating that cataract surgery is not likely to cause AMD progression, Timothy W Olsen MD told delegates attending yesterday’s ESCRS Clinical Research Symposium on Cataract and Macular Disease in Copenhagen. “The key to this is carefully managing patients’ expectations and to be honest with them about what to expect in the course of managing these two age-related conditions. We cannot prevent the ageing process but I think the key concept to keep in mind relates to optimising ageing,” said Dr Olsen, Emory University, Atlanta, USA. Epidemiological studies clearly show the extent of the task facing eye care physicians in the near future, said Dr Olsen. “The projections for advanced AMD in the US alone are an incidence of 125,000 patients per year treated, and 25,000 new cases every year by 2020. For cataracts, about 50% of the population will have visually significant cataract by age 75,” he said. While early population-based studies suggested a possible increased risk of progression to AMD as a result of cataract surgery, Dr Olsen said that this view has since been reappraised. “We need to understand the era in which these studies were conducted. Many of the participants were aphakic and the advanced AMD was actually geographic atrophy. So while alarm bells were ringing, we were all able to breathe a little easier when the AREDS study was published showing no clear effect of cataract extraction on AMD progression. Macular degeneration is going to progress anyway and there may not be as tight a relationship as the population-based studies had shown,” he said.