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Original Investigation |

Cataract Surgery and Age-Related Macular Degeneration in the 2008-2012 Korea National Health and Nutrition Examination Survey

Sang Jun Park, MD, MSc1,2; Ju Hyun Lee, MS3; Soyeon Ahn, PhD3; Kyu Hyung Park, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
3Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
JAMA Ophthalmol. 2016;134(6):621-626. doi:10.1001/jamaophthalmol.2016.0453.
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Importance  In the past, concern has been raised that cataract surgery may be associated with the incidence or progression of age-related macular degeneration (AMD); inconsistent findings from previous studies have puzzled clinicians. In addition, data addressing this association in Asian populations and in the era of phacoemulsification are scarce.

Objective  To determine the associations between cataract surgery and AMD in a representative Korean population.

Design, Setting, and Participants  This cross-sectional study used a multistage, probability-cluster survey sample to produce nationally representative estimates. Data were analyzed from the Korea National Health and Nutrition Examination Survey (KNHANES), which included results for cataract surgery status and AMD grading from 2008 to 2012. A total of 20 419 participants 40 years or older were included. Data were analyzed from February 5 to August 20, 2015.

Main Outcomes and Measures  The association between cataract surgery and AMD was assessed in each right and left eye using logistic regression models and in both eyes using generalized estimating equation models. Sample weights were applied to adjust for survey design, nonresponse, and stratification to generate nationally representative population-based results.

Results  From the 20 419 eligible individuals (11 642 women [51.9%] and 5777 men [48.1%]; mean [SE] age, 55.83 [0.14] years), 17 987 had information regarding cataract surgery status and gradable fundus photographs of at least 1 eye. A total of 34 863 eyes (17 616 right eyes and 17 247 left eyes) underwent analysis. Of these, 1264 right eyes (5.5%) and 1235 left eyes (5.4%) had cataract surgery. Of 1056 right eyes and 949 left eyes with any AMD (early or late), 167 right eyes (15.2%) and 147 left eyes (13.7%) had cataract surgery. The analyses did not show any association between cataract surgery and any form of AMD (early, late, and all) except in left eyes, where cataract surgery was associated with late AMD (odds ratio, 2.34; 95% CI, 1.13-4.85).

Conclusions and Relevance  The results suggest that the association between cataract surgery and AMD is uncertain in the current era of phacoemulsification. The association for left eyes might be a chance finding.

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