REVIEW QUESTION

What is the safety and efficacy of cataract surgery in people with age-related macular degeneration (AMD)?

TYPE OF REVIEW

A systematic review of two randomized controlled trials (RCTs) with a total of 114 participants.

RELEVANCE FOR NURSING

AMD and cataracts are common conditions with overlapping symptoms and risk factors, and both can lead to impaired vision and blindness. The World Health Organization reports that cataracts account for 25% of the world's moderate to severe vision impairment, while AMD accounts for about 4%.

There is no cure for AMD; treatment options include vitamin supplementation, intravitreal injections, laser surgery, and photodynamic therapy. Currently the only treatment strategy for cataracts is surgery involving removal of the lens. Although common practice, cataract surgery may affect the progression of AMD in patients with both conditions, and therefore may be inadvisable in those who already have visual impairment due to AMD. This systematic review was conducted to determine if people with cataracts who also have AMD should undergo cataract surgery.

CHARACTERISTICS OF THE EVIDENCE

The authors examined the safety and efficacy of cataract surgery compared with no surgery or delayed surgery in people with AMD. Trials that included participants needing cataract surgery for angle-closure glaucoma, lens subluxation, or clear lens extraction for refractive error were excluded. The primary outcome of interest was visual acuity; secondary outcomes included progression of AMD, vision-related quality of life, and adverse effects. The length of follow-up ranged from six months to three years.

Only two RCTs met the inclusion criteria and were included in the review. A total of 114 participants were examined. Of those, 57 randomly received surgery within two weeks of being enrolled in the study (immediate); the other 57 were randomized to receive surgery six months after enrollment (delayed).

One study demonstrated that at six months' follow-up, participants who received immediate surgery had significant improvements in corrected visual acuity compared with participants who had delayed surgery. In the second study, because it was unclear how distance visual acuity was measured, there was uncertainty as to whether those who underwent surgery immediately or had delayed surgery saw improvement at 12 months' follow-up. Both studies measured quality of life; however, only one study provided sufficient data, which indicated that participants who received immediate surgery had a better quality of life than those who had delayed surgery. Neither study reported on postoperative complications.

BEST PRACTICE RECOMMENDATIONS

Because of the limited evidence provided in this review, no solid recommendations can be made regarding the safety and efficacy of cataract surgery in people with AMD. The evidence suggests that cataract surgery improves visual acuity in people with AMD compared with no surgery at six months' follow-up; however, it is uncertain if the timing of the surgery plays a role.

RESEARCH RECOMMENDATIONS

There is a need for prospective RCTs to compare cataract surgery with no surgery in patients with AMD to better determine whether cataract surgery is beneficial or harmful in this group. Until more high-quality studies are undertaken, nurses who advise patients who have both AMD and cataracts and who are considering their treatment options must take into consideration factors such as the patient's comorbidities, living situation, available support, and quality of life.

REFERENCE