Older adults often have both age-related cataracts and age-related macular degeneration, and there has long been controversy over whether cataract surgery affects age-related macular degeneration. Previous reports have suggested that cataract surgery accelerates the progression of age-related macular degeneration, while recent reports have suggested that cataract surgery does not accelerate the progression of age-related macular degeneration, but rather improves the visual function of the patient, due to the advancement of cataract surgery and the use of ultrasound emulsification technology. Age-related cataracts and age-related macular degeneration (AMD) often coexist in older adults, and both diseases are the most common causes of visual impairment in older adults. Cataract is the leading cause of blindness worldwide, causing 17.6 million people worldwide (39%), and AMD is another major cause of blindness in people over 65 years of age. The prevalence of AMD among people over 50 years of age in a domestic area was 8.4% in a survey by He Mingguang et al. While cataract is curable blindness, AMD is incurable blindness, and AMD is often an important factor for unsatisfactory visual acuity after age-related cataract surgery. As aging increases and the incidence of AMD increases each year, it is important to assess the risks and benefits of cataract surgery for this group of patients. However, to date, no definitive conclusions have been made regarding the effect of cataract surgery on AMD progression. So, what is the relationship between cataract surgery and the progression of AMD? Is cataract surgery appropriate for patients with non-neovascular AMD? Does cataract surgery lead to progression from intermediate AMD (extensive moderate-sized vitreous warts, large vitreous warts, or map-like atrophy of the nonmacular central hollow) to neovascular AMD? risk factor” for AMD in the long term. A. Cataract surgery is thought to accelerate the progression of AMD Several studies have linked cataract surgery to the progression of AMD. The strongest evidence comes from the Beaver Dam Eye Study and the Blue Mountains Eye Study, which found a 3- to 4-fold increased risk of choroidal neovascularization (CNV) 10 years after cataract surgery.2,3 In 1979, Blair et al [4 ] first reported cataract surgery leading to AMD progression, and they found that within 6 months after cataract surgery, fundus fluorescein angiography (FFA) in 4 patients (6 eyes) showed hemorrhagic retinal pigment epithelial detachment secondary to AMD, but only 1 eye had preoperative FFA documented, so whether preoperative The presence of CNV could not be excluded. In a clinical study evaluating AMD progression in early AMD with unilateral ECCE+IOL surgery, 19% of operated eyes progressed to wet AMD compared with 4% of unoperated eyes, and soft vitreous warts and men were considered risk factors. In a prospective study by Pollack et al.[6] in 1998, a patient with bilateral early AMD who underwent unilateral cataract surgery with a history of stable AMD and cataract surgery in the other eye had a significantly higher progression to CNV within one year after surgery in the second eye. Furthermore, after YAG posterior capsulotomy in IOL eyes with a history of stable AMD for at least 1 year, 13% of the eyes progressed to wet AMD within 12 months, while no wet AMD occurred in the other eye, suggesting that soft vitreous warts, hypertension, and YAG posterior capsulotomy were important risk factors. Taken together, these studies suggest that progressive AMD (neovascular AMD and map-like atrophy) is more prevalent in patients undergoing cataract surgery or in patients without a lens. Therefore, many people speculate that there is a causal relationship between cataract surgery and neovascular AMD. Second, cataract surgery improves visual acuity in AMD patients without accelerating the progression of AMD Another scholar found that cataract surgery significantly improved visual function and quality of life in AMD patients [7]. In a retrospective study of 99 patients with AMD to determine whether cataract surgery had a subjective benefit for patients, 81% of patients had improved best-corrected visual acuity and 67% of patients considered cataract surgery to be worthwhile. Another report included 187 patients, with or without AMD, who underwent cataract surgery, all of whom had significant improvements in visual function and quality of life after surgery, and no increase in wet AMD was found. A prospective case-control study of AMD reported by Armbrecht et al. including 40 cases in the cataract surgery group and 43 cases in the control group showed no increased risk of CNV with cataract surgery and no CNV in the surgery group at 1 year follow-up, while CNV developed in 2 eyes in the control group. this view is supported by the study of Baatz et al [10], although no baseline FFA was done and it was a retrospective case- controlled study, but with a larger number of cases, 1152 in the cataract surgery group and 334 in the control group, all with cataract combined with early AMD, and 2.43% in the cataract surgery group compared to 1.7% in the control group with CNV 1 year after surgery (p=0.57). Guttman et al. from the Age-Related Eye Disease Study reported 342 patients without neovascular AMD, one group with cataract surgery and the other without surgery, and the two groups were matched for gender, age, baseline AMD disease, and follow-up time. . Chew et al [12], also from the Age-Related Eye Disease Study, conducted a multicenter randomized controlled clinical trial from 1992-2005 and is the only large sample, prospective study of change in AMD before and after cataract surgery with more than 5 years of follow-up. The study included 8050 eyes (4577 cases) with a convincing follow-up every 6 months. Cataract surgery was performed in 1704 eyes, of which 95 (6%) developed neovascular AMD; no cataract surgery was performed in 6448 eyes, of which 448 (7%) progressed to neovascular AMD. statistical analysis showed that there was no significant difference in the incidence of progressive AMD with or without cataract surgery for either neovascular AMD or geographic map-like atrophy. Hooper et al. found in a randomized controlled study that the benefit of cataract surgery for early AMD was evident as long as CNV was not present. After 6 months, one patient (3.7%) in the cataract surgery group progressed to CNV, while no CNV was found in the no cataract surgery group. logMAR visual acuity in the cataract surgery group improved by 2.8 rows . Although the number of cases was small, they found that uncomplicated ultrasound emulsion surgery for a short period of time (6 months) did not increase the risk of progression to CNV in AMD.