TL;DR
The short answer is no. The best available evidence shows that cataract surgery doesn’t cause macular degeneration, and it doesn’t significantly increase the risk of existing age-related macular degeneration (AMD) getting worse. But because both conditions are common in older adults and often appear together, it’s a question that comes up frequently, and it deserves a thorough answer.
Why do people worry about this?
Cataracts and AMD are the two most common causes of vision problems in people over 50. They share many of the same risk factors, including age, smoking and UV exposure, so it’s not unusual for someone to have both conditions at the same time. When a person with early or intermediate AMD is told they need cataract surgery, a natural concern is whether the procedure could somehow trigger or accelerate their macular degeneration.
This worry isn’t entirely unfounded. Older studies produced mixed results, with some suggesting a possible link between cataract surgery and faster AMD progression. The problem with many of those studies was that they were observational, meaning they could show a correlation but couldn’t prove that one thing actually caused the other.
People who needed cataract surgery were already older and had more risk factors for AMD, so it was difficult to separate the effects of surgery from the natural course of the disease.
What the research actually says
The strongest evidence we have comes from the Age-Related Eye Disease Study 2 (AREDS2), a large clinical trial run by the US National Eye Institute. Researchers followed over 900 AMD patients who had cataract surgery and compared them to a matched group who didn’t. Over up to 10 years of follow-up, they found no increased risk of progression to late-stage AMD in the group that had surgery.
This was an important finding because AREDS2 was a well-designed, prospective study with long-term follow-up, which carries much more weight than the retrospective studies that had raised concerns earlier. A systematic review and meta-analysis that pooled data from multiple studies also found no statistically significant increase in AMD progression risk after cataract surgery in the short to medium term.
There is one nuance worth mentioning. Some meta-analyses have found that beyond five years after surgery, there may be a moderately higher risk of AMD progressing to later stages. But it’s still unclear whether this reflects a genuine effect of the surgery itself or simply the fact that both conditions worsen with age.
The consensus among ophthalmologists is that cataract surgery is safe for people with AMD and shouldn’t be avoided out of fear of making the macular degeneration worse.
Cataract surgery won’t fix AMD-related vision loss
While cataract surgery can safely be performed on someone with macular degeneration, it’s important to have realistic expectations about what it will and won’t do.
Cataract surgery works by replacing the cloudy natural lens of the eye with a clear artificial one. This removes the haze and blur caused by the cataract, allowing more light to reach the retina. If a significant portion of your vision loss is due to the cataract, you’ll likely notice a real improvement after surgery.
But cataract surgery can’t repair damage to the macula. If AMD has already caused changes to your central vision, such as blurriness, distortion or a blind spot, those problems will still be there after the cataract is removed. In some cases, people find that their AMD symptoms actually seem more noticeable after surgery, not because the macular degeneration has worsened, but because removing the cataract reveals vision loss that was previously masked by the general cloudiness.
Your ophthalmologist will assess how much of your vision loss is caused by the cataract versus the AMD before recommending surgery. If the cataract is contributing significantly, the procedure is usually worthwhile. If most of the vision loss is from AMD, the benefit of surgery will be more limited.
What happens after surgery if you have AMD
If you have AMD and go ahead with cataract surgery, regular follow-up is essential. Your ophthalmologist will want to monitor the back of your eye closely in the months and years after the procedure, looking for any signs that the AMD is progressing.
TThis is particularly important if you have intermediate AMD or if you’ve already lost vision in the other eye to advanced AMD. People in these groups have a higher natural risk of progressing to late-stage disease regardless of whether they have cataract surgery, so staying on top of monitoring means that any changes can be caught and treated quickly.
One benefit of having the cataract removed is that it actually makes it easier for your eye care team to examine the retina. A cloudy lens can obscure the view of the macula during eye exams, making it harder to detect subtle changes. After surgery, the view is much clearer, which means any early signs of wet AMD or geographic atrophy are more likely to be spotted in time.
How to protect your eyes if you have both conditions
If you’re living with both cataracts and AMD, there are a few practical things you can do to look after your eye health.
Don’t miss doctor’s appointments
Keep up with your eye appointments, even if your vision feels stable. AMD can progress without obvious symptoms, particularly in the early stages, and your optician or ophthalmologist will be able to pick up changes that you might not notice yourself.
Use an Amsler grid
Use an Amsler grid at home to monitor your central vision between appointments. If you notice any new waviness, distortion or blank patches, contact your eye care professional straight away. These could be early signs of macular degeneration progressing to its wet form, which needs prompt treatment with anti-VEGF injections.
Reconsider your diet
The AREDS2 study found that specific nutrients, including lutein, zeaxanthin, zinc, copper and vitamins C and E, can reduce the risk of intermediate AMD progressing to advanced disease by around 25%. You’ll find many of these in leafy greens, colourful vegetables, nuts and oily fish. If your diet doesn’t cover these consistently, a targeted eye health supplement based on the AREDS2 formula may be worth discussing with your optician.
Stop Smoking
Finally, if you smoke, stopping is one of the most effective things you can do. Smoking is a major risk factor for both cataracts and AMD, and quitting can slow the progression of both conditions.
Should you go ahead with cataract surgery?
Cataract surgery doesn’t cause macular degeneration, and current evidence supports it being safe for people who already have AMD. If cataracts are significantly affecting your vision and your ophthalmologist recommends surgery, there’s no good reason to delay it based on AMD concerns alone.
The key is to continue monitoring your macular health closely after the procedure and to take the steps you can to support your eyes for the long term.
