Can Cataract Surgery Cause Macular Degeneration?
Many people can really benefit from cataract surgery but is this at the risk of developing a chronic condition such as macular degeneration? What about if you already have macular degeneration - can there be more problems with cataract surgery than its worth?
Cataract surgery does not cause macular degeneration. There is no evidence that it can make macular degeneration get worse. On the contrary, cataract surgery can be beneficial for patients with macular degeneration to improve their vision, function and quality of life.
Here is what you must know about the link between cataract surgery and macular degeneration. Let’s begin at the retina.
At the back of our eye is our retina. All the light that enters our eye is focused on the retina. The retina works like the image processor and transmits all this visual information to our brain to interpret and give us vision.
The eye & retina; Image by Rhcastilhos. And Jmarchn., CC BY-SA 3.0, via Wikimedia Commons / modified from original
The very center point of the retina is called the macula. Being at the center of our retina, the macula is also at the center point of our vision. Whenever we look at an object, this object is projected onto our macula. It gives us the ability to see very fine details of whatever we are looking at.
Needless to say, conditions that affect the macula can cause quite a bit of vision impairment.
What Is Macular Degeneration?
As the name implies macular degeneration occurs when the macula breaks down over time.
- The retina can become thin and less effective at serving its role as the image processor for the brain. This is known as dry macular degeneration
- As macular degeneration progresses, abnormal blood vessels can grow underneath the retina. These can bleed and leak and cause sudden blurry vision. This is known as wet macular degeneration.
Either of these two things can cause vision loss, but wet macular degeneration is especially known to cause severe distortion or loss of vision.
Central vision loss from wet macular degeneration; image by krakenimages on Unsplash / modified from original
Because macular degeneration involves the central part of our vision, vision loss is most severe exactly where we need to look at objects and faces.
It’s understandable that we want to prevent macular degeneration as much as possible.
Avoiding Macular Degeneration
There are some conditions that can increase the risk of getting macular degeneration
- Older Age
- High cholesterol
- Heart disease
- Family history of macular degeneration
While the exact mechanism for why macular degeneration develops is incompletely understood, it is known that all of these conditions can put extra stress on our retina (as well as many other locations around the body). This stress comes in the form of inflammation and oxidative damage. The build-up of this damage can cause degeneration of the retina over time.
Relationship of Macular Degeneration to Cataract Surgery
So how can cataract surgery potentially cause macular degeneration?
When the lens inside our eye gets cloudy and becomes a cataract, this lens / cataract is removed and replaced with an artificial lens through cataract surgery. This new lens is completely clear! This makes sense; after-all, the goal of cataract surgery is to improve vision.
Prior to cataract surgery, the cataract is cloudy. This cloudiness can actually serve a small purpose. It acts almost like built-in sunglasses. Cataracts are effective at filtering out light. This includes short-wavelength light such as blue light. Blue light can actually cause additional stress to our retina!
When we replace the cataract with a clear lens, our retina will receive more light - including more blue light.
Cataract surgery can also increase the amount of inflammation inside the eye. The lens inside our eye is actually “foreign” to our immune system. Normally, the lens inside our eye is sealed in its own compartment (called the capsule) and nothing happens. Our immune system can’t get to the lens unless there is some sort of trauma that causes a break in this capsule and exposes the lens to the rest the eye.
But this capsule is intentionally opened during cataract surgery. While almost 100% of the lens / cataract is removed, there is still some microscopic remains of it which can cause a little more inflammation after cataract surgery (this is the reason for steroid eye drops after cataract surgery - to treat this inflammation). This inflammation can potentially travel to the back of the eye and affect the retina.
Cataract Surgery Has No Known Effect On Macular Degeneration
Despite the potential risks of more blue light and more inflammation, there has been no evidence of cataract surgery causing macular degeneration or causing it to get worse.
There is still more to learn about blue light and its relationship to macular degeneration. And cataract surgery has also improved over the years. As techniques have become more modern, inflammation after surgery has dramatically reduced.
But overall, the retina doesn’t appear to experience much stress after cataract surgery.
Cataract Surgery Can Be Beneficial
In fact, there is a good reason why cataract surgery should be performed for many patients with macular degeneration.
Macular degeneration causes severe vision loss. And this vision loss is the most severe right in the center of your vision. This can make it very difficult to perform everyday tasks.
Cataracts will also cause vision loss. The vision loss from cataracts can compound the already impaired vision from the macular degeneration. This can severely reduce function and quality of life.
Fortunately, the vision loss from cataracts can be treated and the vision restored. While this won’t reverse the vision loss from macular degeneration, it can help improve overall vision and function (as long as the cataracts were a significant cause of the impaired vision; if the vision loss was entirely from the macular degeneration then cataract surgery won’t have much of an effect).
In general, it is best to listen to your eye doctor or retina doctor about whether you should have cataract surgery if you have macular degeneration. If you are having active swelling or bleeding, then perhaps waiting until everything stabilizes first is the best route to take.
If you have cataracts and need cataract surgery, you don’t need to worry about cataract surgery causing you to get macular degeneration or cause your macular degeneration to get worse. It can still happen just due to other causes but there is no evidence that points the finger at cataract surgery as a risk factor.
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