Macular disease and cataracts: Threshold for surgery should be low

Cataract surgery in patients with macular disease should be performed if the patient has cataract-related visual symptoms, according to Sebastian Wolf MD, PhD. “The take-home message is that the threshold for cataract surgery should be low and even patients with reduced visual potential may benefit from cataract surgery,” Dr Wolf told delegates attending yesterday’s ESCRS Clinical Research Symposium on cataract and macular disease in Copenhagen. Dr Wolf, of Switzerland, said that the question of whether cataract surgery is safe for someone with age-related macular degeneration (AMD) or other retinal disease is regularly posed by both patients and their treating physicians. While patients often worry that having the surgery will worsen their disease, there is no clear evidence that cataract surgery promotes AMD progression, he said. Dr Wolf said that cataract surgery is indicated when vision loss interferes with everyday activities. “We need to remember that cataract removal is one of the most common, safest and effective operations in medicine. In more than 90% of cases, people who have cataract surgery have better vision afterwards. Cataract surgery does, however, increase the risk of retinal detachment and it is true that the interaction between macular disease and cataract surgery is still very much under discussion,” he said. In terms of diagnostics that best predict the risk-benefit curve in patients with cataract and macular disease, Dr Wolf warned that ophthalmoscopy may be compromised by the presence of cataract. By contrast, optical coherence tomography (OCT) is also particularly useful in such patients, he said. “We typically use OCT, and the big advantage of this is that infrared light can penetrate even dense nuclear cataracts and give us a clearer view of the retina and macula,” he added.