Cataract Surgery and macular degeneration.

Blog vol 5.1. Cataract Surgery and macular degeneration.


What if you have macular degeneration and are receiving Anti-VEGF (anti-vascular endothelial growth factor) injections, can you go ahead with cataract surgery? A unique situation, but one I ran into this past week, and not so uncommon as you would think.


For 90% of patients, Anti-VEGF injections for wet macular degeneration arrest the condition, and up to 33% see some visual improvement, a wonderful thing. This treatment, any effective treatment, is relatively new. When I started practising in the late 1980s, there was no treatment that worked to stop macular degeneration, consequently, we did not worry about cataracts. This is a very good problem we are discussing. 


Current cataract surgery, the removal of the cloudy lens from the eye and the replacement with a clear intra-ocular implant is a well-proven treatment for cataracts.


So far so good, but what happens if we mix the two together?  


As we go along and develop new procedures we meet with new dilemmas. In the past, most wet macular degeneration patients would lose substantial vision, to the point that cataract surgery would not be done because very little improvement of vision would be attained. Not worth the risk. But with anti-VEGF injections, most patients can be kept at a functional level of vision, so cataract surgery becomes helpful.


Long-term studies, like AREDS2 (see here), have found that cataract surgery does not significantly affect the macula. That is good. In 2019 a study was done co-ordinating the two procedures (we are not the only ones wondering about this): anti-VEGF treatments for wet macular degeneration and cataract surgery (see here). This study found that the injections did not detrimentally affect the cataract surgery outcomes.


Not surprisingly, the consensus among retinologists (ophthalmologists who specialize in retina issues) is that the wet macular degeneration has to be stable before attempting cataract surgery. The person receiving injections must a have stable retina, as judged by the retinologist, and then be scheduled for surgery. 


If you are in this situation, make sure that the injections are working, then look into cataract surgery. We see a lot of people after cataract surgery, and we see a lot of people getting injections. Outcomes have been very promising.   



Til next week,



 

The good doctor


By Dr. Mark Germain May 1, 2026
The good doctor discusses how the eye is a window to the heart with the help of the OCT.
The good doctor take a deeper look at how gut health is connected to eye tissues.
By Dr. Mark Germain April 29, 2026
Blog vol 6.40. The Gut and the Eyes. One of my biggest jobs is to keep abreast of new research and advances in eye health. Most recently, we have seen new stem cell research, gene therapies, as well as new drugs for dry and wet macular degeneration. In January of this year, there was an article in the journal, Cell Death and Disease, that looked at cell apoptosis, specifically with the photoreceptors of the eye. (Read the article here ). Apoptosis is the genetic programming of deliberate and constructive cell death, allowing for the maintenance of healthy structures and systems in the body. Some estimates have the body replacing 50 to 70 billion cells daily by this process. Necrosis, on the other hand, is unplanned cell death caused by injury, toxins, or other negative outside factors; this causes inflammation and disrupts the body’s balance of things. There are stressors that speed up cell turnover. The study looked at photoreceptors in the retina and were able to demonstrate cellular recovery, even in late stages of apoptosis, recovery not breakdown. When certain stressors were reduced, by working with the mitochondria, there was recovery of the photoreceptor cells. How? Mitophagy, the mitochondria’s own process of programmed breaking down and then repurposing the recycled components for new ones. This mitochondrial repair helps to reverse the sequence of apoptosis for the photoreceptors. Mitochondria, how cool. How is this helpful for our eyes? Conditions like retinitis pigmentosa or macular degeneration directly involve the photoreceptors and may be slowed or reversed by helping the mitochondria. So, let’s take care of those mitochondria. There is some evidence for nutritional support for the mitochondrial system. The nutrient, Urolithin A (UA), which is a compound made in our gut from fiber found in pomegranates, berries, and nuts is the only clinically proven substance known to trigger mitophagy, made in the gut no less. Vitamin B3 is critical for mitochondria function, however vitamin B3 based supplements are still to be clinically tested for their support of cell recovery. Nutrients Coenzyme Q10 and L-carnitine are known to help the mitochondria generate energy, and interestingly, infrared light therapy has also been shown to benefit mitochondrial function. Again, food for thought. The gut and its function needs a lot of research. How do probiotics and nutrient precursors affect eye tissues? It is so interesting that the gut can be a factor in eye health. Maybe adding Urolithin A as a supplement is wise, along with the antioxidants in Lutein and Zeaxanthin we use to combat photoreceptor degeneration. Will keep you posted on any new developments.  The good doctor
By Dr. Mark Germain April 16, 2026
The good doctor focuses in on visual processing. Why do we miss things that are right in front of our eyes?
By Dr. Mark Germain April 10, 2026
The good doctor discusses the Artemis II mission, space travels affects on the eyes, and "the dark side of the moon"
By Dr. Mark Germain April 3, 2026
The good doctor discusses exciting new and emerging options to treat nystagmus.
By Dr. Mark Germain March 27, 2026
The good doctor reflects on The Country of the Blind, a book by Andrew Leland which gives insight into the experience of vision loss.
More Posts