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Excellent question. We are often faced with the question of which eye disease is responsible for the bulk of the visual loss. This is especially true when contemplating cataract surgery—both to decide whether the surgery is indicated and, if so, to educate the patient on the prognosis and expectations. An ophthalmologist can often look at a cataract and determine whether it is potentially visually significant. It has been shown that patients with severe AMD often benefit from cataract surgery but, of course, are limited by their AMD after the surgery. Some office testing can give an idea of vision after cataract surgery, but these tests are not completely accurate.
In my practice, I look at the vision, the degree of cataract and the health of the macula using tests such as fluorescein angiogram and OCT. Having done this I will decide that a) cataract surgery won't help at all (cataract is not advanced and AMD is advanced), b) cataract surgery is needed but the chance for improved vision is very small, or c) cataract surgery is needed and there will likely be a significant improvement in vision. This is a clinical judgment and one that also involves patient education and appropriate informed consent.
Answered by: Gary Hirshfield, MD
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Answered: Jul 21, 2014
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