No Increase in Neovascular AMD Risk After Cataract Surgery

New data published in JAMA Ophthalmology adds clarity to a longstanding clinical question: whether cataract surgery accelerates the progression of nonneovascular age-related macular degeneration (AMD) to its neovascular form.

For years, ophthalmologists have weighed the visual benefits of cataract extraction against concerns that surgery might trigger or hasten conversion to neovascular AMD (nAMD), a complication associated with rapid central vision loss. The latest findings suggest those concerns may be overstated.

In a retrospective cohort study spanning nearly two decades of clinical data—from 2006 through 2025—researchers led by Victor Bellanda, MD, of the Cleveland Clinic’s Cole Eye Institute examined whether cataract extraction with intraocular lens implantation influences the likelihood of developing nAMD. The investigators analyzed a large dataset of adults aged 60 years or older who had no prior pseudophakia. Their analysis compared patients who underwent cataract surgery with individuals who had no record of surgical treatment.

The study initially identified 132,122 patients who received cataract surgery and 407,579 control patients. To reduce bias and account for potential differences in baseline characteristics, the researchers used propensity score matching, ultimately producing two balanced cohorts of 122,384 individuals each. Within this broader population, the investigators also evaluated a subgroup of patients already diagnosed with nonneovascular AMD—a population in which clinicians are often particularly cautious about recommending cataract surgery. After matching, this subgroup analysis included 14,049 individuals in both the surgical and nonsurgical groups.

Across multiple follow-up intervals, the investigators found no meaningful increase in the risk of developing neovascular AMD among patients who underwent cataract surgery. At one month after surgery, the incidence of nAMD was nearly identical between groups—0.11% among surgical patients compared with 0.11% among controls—yielding a risk ratio of 1.05. Even at longer follow-up periods, the differences remained small and statistically nonsignificant. At 24 months, for example, the cumulative risk was 0.90% in the surgical group versus 0.79% in the control group, corresponding to a risk ratio of 1.14. Importantly, the 95% confidence intervals for these risk ratios remained within the study’s predefined nonsignificance range, indicating that cataract surgery did not meaningfully alter the risk of conversion to nAMD.

The analysis of patients with preexisting nonneovascular AMD produced similarly reassuring findings. Although the investigators observed a temporary decrease in conversion risk three months after surgery—reflected by a risk ratio of 0.71—this apparent reduction did not persist at later time points. Over the longer term, the rate of progression to neovascular AMD in this subgroup remained comparable between patients who underwent cataract extraction and those who did not.

These results challenge a persistent clinical hesitation surrounding cataract surgery in patients with AMD. Historically, some ophthalmologists have delayed or avoided surgical intervention in individuals with advanced macular disease, concerned that postoperative inflammation, increased retinal light exposure, or other physiological changes might accelerate degeneration. At the same time, cataracts themselves can significantly degrade visual function, creating a dilemma for clinicians attempting to balance surgical risks against quality-of-life benefits.

The new findings suggest that cataract extraction may not meaningfully influence the natural course of AMD progression, even among patients already living with the nonneovascular form of the disease. For clinicians, the data provide additional evidence that visual rehabilitation through cataract surgery may remain a reasonable option for many patients with AMD when cataract-related visual impairment becomes significant.

Because the study was retrospective, the authors note that its findings should be interpreted within the limitations of observational research. Even so, the large sample size, extended timeframe, and careful propensity score matching strengthen the analysis and help mitigate potential confounding factors.

For ophthalmologists counseling patients with both cataracts and AMD, the study adds an important piece to the decision-making framework. While individual clinical judgment remains essential—particularly when macular disease is advanced—the evidence suggests that fears of triggering neovascular AMD may not need to weigh as heavily in surgical planning as previously thought.