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Cataract surgery improves VA in patients with wet AMD

VANCOUVER, British Columbia – Visual acuity significantly increased after cataract surgery in patients with neovascular age-related macular degeneration, according to a poster presented here at the Association for Research in Vision and Ophthalmology meeting.

In a retrospective observational clinical study, Andrew X. Chen, BS, Case Western Reserve University School of Medicine, Cleveland, and colleagues from Cole Eye Institute evaluated two groups of patients in their 70s who underwent cataract surgery: 188 with wet AMD who received anti-VEGF therapy prior to surgery and 129 with no ocular condition that would affect visual acuity.

“Neovascular AMD affects a lot of people of older age, and cataracts are more common in older people as well, but unfortunately one question that has not been fully elucidated is: What is the impact of cataract surgery in those patients?” Chen told Healio.com/OSN. “What kind of improvement in visual acuity can we expect? Are there certain predictive factors that might be characteristic of the disease that we can say will make you a better or worse candidate for surgery?”

Chen and colleagues checked visual acuity preoperatively and at 1 and 12 months postoperatively, and both groups were found to have a significant increase in visual acuity, “though, understandably, a much more significant one for controls,” he said. “There was, on average, at 12 months postop, a 26-letter improvement for the controls vs. a 10-letter improvement for the wet AMD group, which is unsurprising.”

Chen said they also looked at prognostic factors to determine which patients with wet AMD may be better candidates for surgery and if any can predict how much visual acuity gain patients will have.

Prognostic factors included hemorrhage, active choroidal neovascular lesion, presence of fibrosis, as well as subretinal fluid and geographic atrophy as seen on OCT.

“Of those factors, we found that the preop visual acuity was the only significant predictor of postop visual acuity, with patients who had a lower baseline vision experiencing a greater increase in letters,” he said.

“The clinical question we’re trying to answer is if a patient comes to us and asks if they have cataract surgery, how much will it really improve their vision – that’s the question that matters,” Chen said.

The researchers also looked at the frequency of anti-VEGF injections before and after surgery, “because the question has been raised: Does the cataract surgery itself exacerbate the underlying wet AMD, or are inflammatory changes worse in the disease? We found no difference in injection frequency before and after surgery,” Chen said. “If anything, we found a trend toward fewer injections after surgery. A hypothesis for that might be that they’re on a stable regimen of anti-VEGF therapy, and the disease process is stabilizing.” – by Nancy Hemphill, ELS, FAAO

Reference:

Chen AX, et al. Visual outcomes following cataract surgery in neovascular age-related macular degeneration patients in routine clinical practice. Presented at: Association for Research in Vision and Ophthalmology; April 28-May 2, 2019; Vancouver, British Columbia.

Disclosures: Chen reports no relevant financial disclosures. Please see study abstract for all other authors’ disclosures.

 

VANCOUVER, British Columbia – Visual acuity significantly increased after cataract surgery in patients with neovascular age-related macular degeneration, according to a poster presented here at the Association for Research in Vision and Ophthalmology meeting.

In a retrospective observational clinical study, Andrew X. Chen, BS, Case Western Reserve University School of Medicine, Cleveland, and colleagues from Cole Eye Institute evaluated two groups of patients in their 70s who underwent cataract surgery: 188 with wet AMD who received anti-VEGF therapy prior to surgery and 129 with no ocular condition that would affect visual acuity.

“Neovascular AMD affects a lot of people of older age, and cataracts are more common in older people as well, but unfortunately one question that has not been fully elucidated is: What is the impact of cataract surgery in those patients?” Chen told Healio.com/OSN. “What kind of improvement in visual acuity can we expect? Are there certain predictive factors that might be characteristic of the disease that we can say will make you a better or worse candidate for surgery?”

Chen and colleagues checked visual acuity preoperatively and at 1 and 12 months postoperatively, and both groups were found to have a significant increase in visual acuity, “though, understandably, a much more significant one for controls,” he said. “There was, on average, at 12 months postop, a 26-letter improvement for the controls vs. a 10-letter improvement for the wet AMD group, which is unsurprising.”

Chen said they also looked at prognostic factors to determine which patients with wet AMD may be better candidates for surgery and if any can predict how much visual acuity gain patients will have.

Prognostic factors included hemorrhage, active choroidal neovascular lesion, presence of fibrosis, as well as subretinal fluid and geographic atrophy as seen on OCT.

“Of those factors, we found that the preop visual acuity was the only significant predictor of postop visual acuity, with patients who had a lower baseline vision experiencing a greater increase in letters,” he said.

“The clinical question we’re trying to answer is if a patient comes to us and asks if they have cataract surgery, how much will it really improve their vision – that’s the question that matters,” Chen said.

The researchers also looked at the frequency of anti-VEGF injections before and after surgery, “because the question has been raised: Does the cataract surgery itself exacerbate the underlying wet AMD, or are inflammatory changes worse in the disease? We found no difference in injection frequency before and after surgery,” Chen said. “If anything, we found a trend toward fewer injections after surgery. A hypothesis for that might be that they’re on a stable regimen of anti-VEGF therapy, and the disease process is stabilizing.” – by Nancy Hemphill, ELS, FAAO

Reference:

Chen AX, et al. Visual outcomes following cataract surgery in neovascular age-related macular degeneration patients in routine clinical practice. Presented at: Association for Research in Vision and Ophthalmology; April 28-May 2, 2019; Vancouver, British Columbia.

Disclosures: Chen reports no relevant financial disclosures. Please see study abstract for all other authors’ disclosures.

 

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