• Cataract/Anterior Segment, Refractive Mgmt/Intervention, Retina/Vitreous

    Review of: Patient management modifications in cataract surgery candidates following incorporation of routine preoperative macular optical coherence tomography

    Weill Y, Hanhart J, Zadok D, et al. Journal of Cataract & Refractive Surgery, January 2021

    This single-center retrospective study assessed the clinical relevance of routine preoperative spectral-domain OCT for identifying macular pathologies in patients scheduled for cataract surgery.

    Study design

    Researchers examined 453 eyes from patients aged 50 years or older undergoing surgery during a 3-month period; 42 eyes were excluded because of poor image quality. Scans were interpreted by a single retina specialist who was masked to the results of the slit-lamp biomicroscopy. Macular pathology was graded as missed (not seen on biomicroscopy) or underestimated (seen on biomicroscopy but were not serious enough to merit retinal consultation).

    Outcomes

    Imaging detected macular pathology in 41% of eyes; nearly half of these eyes (23%) did not have pathology on slit-lamp biomicroscopy. Half of abnormal OCTs had macular degeneration and 28% had epiretinal membrane. Imaging by OCT changed management for 26% of eyes, resulting in further preoperative counseling such as discouraging the use of a presbyopia-correcting IOL (28%) or a referral to a retina specialist (8%). Older patients and those with diabetes were significantly more likely to have abnormal macular OCT.

    Limitations

    It was not possible to make a clinical correlation because the macular OCT was interpreted by a masked retina specialist. The preoperative exam may have been imperfectly documented in the patient chart, with findings left out. Since this data was collected at a tertiary referral center, the cohort may not reflect general cataract surgery.

    Clinical significance

    This study reinforces the benefit of preoperative macula OCT in certain patients, especially those interested in a presbyopia-correcting IOL. Routine preoperative OCT is not covered by insurance, but this paper offers some evidence supporting reimbursement.