Elsevier

Ophthalmology

Volume 113, Issue 11, November 2006, Pages 2020-2025
Ophthalmology

Original Article
Cataract Surgery and the 10-Year Incidence of Age-Related Maculopathy: The Blue Mountains Eye Study

https://doi.org/10.1016/j.ophtha.2006.05.047Get rights and content

Purpose

To assess the long-term (10-year) risk of late age-related maculopathy (ARM) in eyes that had previously undergone cataract surgery (before the baseline examination).

Design

Population-based cohort study.

Participants

In the Blue Mountains Eye Study (BMES) cohort, 2335 of 3654 baseline participants ≥49 years old (75% of survivors) were reexamined after 5 years and 1952 (76% of survivors) were reexamined after 10 years.

Methods

At the baseline examination, nonphakic (aphakic or pseudophakic) eyes were identified at slit-lamp examination and confirmed at lens photographic grading. Side-by-side grading of baseline and follow-up stereoretinal photographs was performed using the Wisconsin ARM grading system. Eye-specific data were analyzed using Kaplan–Meier estimates and generalized estimating equation models, adjusting for correlation between the 2 eyes.

Main Outcome Measures

Incident late ARM was defined if either neovascular ARM or geographic atrophy developed in eyes without either lesion at baseline.

Results

After excluding eyes with either late ARM lesion at baseline or that had missing photographs at either examination, 4763 eyes were considered at risk of incident late ARM, including 132 eyes that had cataract surgery before the baseline examination. Late ARM developed in 10 of 132 nonphakic eyes (7.6%) compared to 96 of 4631 phakic eyes (2.1%). After adjusting for baseline age, gender, smoking, and presence of early ARM lesions, nonphakic (cataract surgical) eyes had a 3-fold risk of developing late-stage ARM (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.1–9.9) or neovascular ARM (OR, 3.4; 95% CI, 1.1–10.9) compared to phakic eyes.

Conclusions

Our findings support the hypothesis that the long-term risk of developing late ARM is higher in cataract surgical eyes, consistent with findings from the Beaver Dam Eye Study.

Section snippets

Materials and Methods

The BMES is a population-based cohort study of a suburban Australian population aged ≥49 years at baseline. The study was approved by the human research ethics committees of the Western Sydney Area Health Service and the University of Sydney and was conducted in adherence to the tenets of the Helsinki Declaration. Signed informed consent was obtained from all participants at each examination. Survey methods and procedures have been described previously.22, 23

Briefly, at baseline 3654 of 4433

Results

Of the 3654 baseline participants, 2335 (75.1% of survivors) returned to the 5-year and 1952 (75.6% of survivors) to the 10-year follow-up examinations. Combining persons seen at either or both examinations, 2454 (67.2% of baseline participants) were followed and had retinal photographs available for the assessment of ARM lesions. Surviving participants who did not return to either the 5-year or 10-year follow-up examinations were more likely to be <60 years of age and to have been current

Discussion

In this population-based cohort of older Australians, we report a higher long-term (10-year) risk of developing late ARM in eyes that previously had cataract surgery (prior to the baseline examinations) than in phakic eyes at baseline. The association was similar in magnitude to that found in the BDES: increased odds of 3.3 for the development of late ARM in nonphakic compared with phakic eyes was observed in our study population; corresponding odds of 3.8 was reported by BDES investigators.20

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    • Cited by (0)

    Manuscript no. 2006-13.

    The authors have no commercial or proprietary interest in the products or companies mentioned in the article.

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    Copyright © 2006 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.