Macular OCT assists preop cataract surgery evaluation

In a retrospective study, preoperative macular OCT identified macular pathology overlooked on fundus examination, and the findings led to management changes in a large percentage of patients.

Reviewed by Yishay Weill, MD

Results of a retrospective study support the routine use of macular optical coherence tomography (OCT) for preoperative screening of patients scheduled for cataract surgery, according to Yishay Weill, MD. The research evaluated data from 226 consecutive eyes of 226 patients referred to Shaare Zedek Medical Center, Jerusalem, Israel, for cataract surgery during the last two months of 2017.

It found that the macular OCT was normal in 51% of eyes and uninterpretable due to low quality in 9%. However, macular pathology was identified in 40% of the eyes. Importantly, the pathology was overlooked in the referral examination in 51% of the eyes with pathology, and its presence led to a change in management in 14% of patients.

“Cataract surgery is now a combined rehabilitative and refractive procedure, and our patients’ expectations are higher than ever,” said Dr. Weill, resident, Department of Ophthalmology, Shaare Zedek Medical Center. Dr. Weill noted that the dilated clinical fundus examination is currently considered the standard of care for preoperative evaluation of the macula.

“Its limited ability to detect pathology in patients with opaque media is a specific concern in the setting of patients presenting for cataract surgery,” he pointed out.

Dr. Weill also explained that overlooked macular pathologies might lead to suboptimal postoperative results, such as unexpected low BCVA and worsening of baseline macular pathology, and that will in turn could lead to dissatisfied patients.

RELATED: Managing dry eye key to patient satisfaction after cataract, refractive surgeries“Preoperative OCT allows better patient management in terms of guiding appropriate surgery planning, timing, modification of consent, patient counseling, and matching patient expectations,” Dr. Weill said. “At our institution, a policy for routinely performing macular OCT for screening of cataract patients was implemented during the second half of 2017.”

The 226 patients included in the research study had a mean age of 73 years, were predominantly female (57%), and were seen by their referring eye care practitioner at an average of 59 days before their preoperative OCT.

The macular OCT was performed with a spectral-domain system (Spectralis, Heidelberg Engineering). All of the OCT scans were then reviewed by a retina specialist. Some of the patients found to have macular pathologies had more than one finding. The most common macular pathologies were age-related macular degeneration (43 eyes), epiretinal membranes (27 eyes), and cystoid macular edema (18 eyes).

“All patients found to have macular pathologies were disqualified as candidates for a multifocal IOL,” said Dr. Weill. In some patients, discovering overlooked macular pathology using OCT led to a delay in surgery, and an offering of combined surgery to address the macular pathology and cataract, or use of adjunctive therapy, such as an intravitreal injection of a corticosteroid or anti-VEGF agent.

Dr. Weill also pointed out that preoperative macular OCT is easy to implement because it is widely available, non-invasive, and quick. However, he concluded that the need for research to evaluate the cost-effectiveness of its routine use for preoperative evaluation of cataract surgery patients.

Disclosures:

Yishay Weil, MD
E: yishayweill@gmail.com
This article is adopted from a presentation by Dr. Weill at AAO2018. He has no relevant financial interests to disclose.