1 Oxford Eye Hospital, Oxford,
² Vision Impairment Research Group, Heriot-Watt University, Edinburgh,
³ Princess Alexandra Eye Pavilion, Edinburgh.
United Kingdom.

Ocular co-morbidities are frequently a risk factor for poor visual outcome of cataract surgery. The most prevalent co-morbidity with cataract is age related macular degeneration (ARMD) and considerable controversy exists concerning the potential benefits of cataract surgery to patients with ARMD.

To determine the effect on quality of life indicators and perceived satisfaction following cataract surgery in patients with ARMD.

The study population comprised 227 patients with a mean age of 79 years from two surgical centres, Oxford and Edinburgh.

Patients were classified according to three groups: ARMD alone, ARMD and Cataract with surgery, ARMD and Cataract without surgery. International classification procedures were used to grade the ARMD and cataract. Measures of visual function included log-MAR visual acuity, contrast sensitivity in the presence and absence of glare, colour vision, stereo acuity and dark adaptometry. A questionnaire, comprising psychosocial factors, a scale of activities of daily living and the VF-14 scale, was administered on two separate occasions to each patient with an interval of four months. For the surgery groups, the initial visual function tests and questionnaire were carried out before surgery.

The data was subjected to several multivariate and univariate statistical analyses (e.g. multivariate ANOVAs, logistic regression analyses, principal component analyses and non-parametric statistics).

There was a low (<2%) risk of ARMD converting to the more severe "wet form" and the progression was not significantly different between the surgical and non-surgical group. Patients with ARMD benefit from cataract surgery, the greatest benefits occurring in those patients with moderate cataract, irrespective of whether their maculopathy is mild or moderate. While distance visual acuity is the single best predictor of quality of life for all patients, contrast sensitivity (including inter-eye difference in contrast sensitivity) is more strongly related to post surgery quality of life benefits. Principal component analyses suggest that patient’s expectations of surgical outcome relate more closely to general aspects of quality of life than to the accomplishment of specific tasks. The implications for rehabilitation will be discussed.