Cataract surgery and the 10-year incidence of age-related maculopathy - The Blue Mountains Eye Study

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% Cl, 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. (c) 2006 by the American Academy of Ophthalmology.