Cataract extraction is of undisputed efficacy in terms of improvements in both vision and quality of life. However, the benefits (and risks) of cataract surgery in patients with concomitant ocular diseases, such as age related macular degeneration (ARMD), are uncertain. With rapidly ageing populations and greater life expectancy, the number of patients with both cataract and ARMD will inevitably increase. How do we manage these patients? Is cataract surgery justified? Are there some who will benefit more than others? Conversely, does cataract surgery aggravate ARMD in other patients? Reliable data are lacking, but these issues are clearly important.

The paper by Armbrecht and colleagues in this issue of theBJO (p 1343) therefore represents an important and timely contribution to the literature. In this prospectively designed study of 187 patients, 90 with ARMD who underwent cataract surgery and two control groups (one with ARMD without cataract surgery and another without ARMD but with cataract surgery), the authors found significant improvements in both visual function and quality of life in patients with ARMD who had cataract surgery. Specifically, patients with mild and moderate ARMD benefited most from cataract surgery, …