Study Identifies Small Increase in Wet AMD Conversion Following Cataract Surgery

A large IRIS Registry analysis of more than 80,000 matched eyes found cataract surgery was associated with a modest increase in conversion from dry to neovascular AMD. The effect was strongest during the first year after surgery and declined to nonsignificance by year four. Researchers emphasized that the small absolute risk difference and time-dependent pattern do not support a causal long-term effect of surgery. Photo: Carolyn Majcher, OD. Click image to enlarge. The association between cataract surgery and the progression of age-related macular degeneration (AMD) has been studied with mixed results. Some have shown an increased risk of late AMD following cataract surgery, while others say there’s no correlation. However, a new study just published in Ophthalmology used a large dataset—the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry—to combat limitations in prior research and employ a more robust statistical analysis. Their results show cataract surgery had a modest increased association in the rate of conversion from dry AMD to neovascular AMD, but there are caveats to note. After one-to-one propensity score matching, the analytic sample included 80,108 eyes (40,053 in each exposed and nonexposed cohort) in patients over age 55. The mean follow-up was 1170 ±644 days. The topline results showed:Cataract surgery was associated with a modest but statistically significant increase in risk of conversion (hazard ratio, HR = 1.92). Time-varying analysis demonstrated that this association was strongest early in follow-up (HR ≈ 2.5 in year one) and declined steadily, reaching nonsignificance (HR ≈ 1) by year four. At year six, the cumulative incidence of neovascular AMD was 17.7% in the exposed cohort vs. 15.2% in the nonexposed cohort. Baseline AMD stage moderated the effect of cataract surgery, with weaker effects of cataract surgery for intermediate AMD ( HR = 0.82).  Factors associated with a statistically significant higher rate of conversion included older age (HR = 1.05), Caucasian rather than Asian race (HR = 1.74), non-Hispanic ethnicity (HR = 1.28), worse baseline BCVA (HR = 1.27 per logMAR unit, and intermediate AMD compared to early AMD (HR = 2.36).Lower rates of conversation were found in Black or African-American compared to Asian race (HR = 0.60), male sex (HR = 0.82) and former (HR = 0.84) and never smoker (HR = 0.68) status compared to active smokers. For clinical guidance on identifying conversion of dry to wet AMD, see this feature. The study’s authors wrote in their paper that, due to its observational design, these findings do not establish a causal relationship between cataract surgery and wet AMD, but they may “inform clinical decision-making and patient counseling when considering cataract surgery in the context of AMD.” In addition to confirming several known risk factors for disease conversion, they wrote that, “while the rate of conversion is higher after cataract surgery for both early and intermediate AMD, the risk of cataract surgery is less pronounced for intermediate AMD than for early AMD, which could reflect a ceiling effect in disease progression.” In clinical settings, the potential risk of AMD progression is a significant concern for patients with AMD undergoing cataract surgery, they continued. “While each case should be considered individually, the findings of this study demonstrated a slight increased risk of conversion to wet AMD following cataract surgery,” they wrote. Although the authors cite several strengths, including the large, matched sample size and long follow-up period, they noted some limitations, namely the aforementioned observational and retrospective design, which could introduce indication bias. Also, the IRIS Registry lacks detailed clinical information, including comorbidities, granular disease severity and imaging findings, which limits confounder control, they wrote.  Although they did identify a modest increased overall rate of conversion from dry to wet AMD, the authors provided the following caveat: “the time-dependent pattern suggests that the observed association likely reflects increased surveillance or unrecognized pre-existing wet AMD rather than a sustained biological effect of surgery. The absolute risk difference was small (~3.3% over six years).” They concluded in their paper that these findings support careful perioperative evaluation in dry AMD patients but do not implicate cataract surgery as a long-term driver of neovascular conversion.Click here for the journal source. Ashourizadeh H, Gilbert JB, Ross C, Kearney WC, Grinspan N, Elze T, Vavvas DG, Miller JW, Lorch AC, Armstrong GW, on behalf of the IRIS® Registry Analytic Center Consortium. Cataract surgery and the risk of conversion from dry to neovascular age-related macular degeneration in the IRIS Registry. Ophthalmology. June 22, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.