XXIX Congress of the European Society of Cataract and Refractive Surgeons

Imaging of the posterior pole as a tool for pre-surgery assessment

"We believe that optical coherence tomography (OCT) of the posterior pole is an integral part of a patient's pre-assessment when considering implantation of a multifocal intraocular lens (MIOL)," stressed Dr Elisabeth Patsoura (OPHTHALMOS Research & Therapeutic Institute, Athens, Greece) on the second day of the annual ESCRS meeting.

Dr Patsoura's talk on her team's experience using the posterior pole OCT for better selection of MIOL patients took place during the Multifocals I session on the second day of the congress. She revealed, "We know that diffractive MIOLs work better in cataract eyes with no concurrent pathology but sometimes it is very difficult to detect subtle changes of the macula."

OCT is a useful diagnostic tool for surgeons, as it can image these macula changes that cannot always be picked up during fundoscopy. "So, the purpose of the study," Dr Patsoura continued, "was to assess the value of OCT in patients waiting to receive a MIOL implantation."

The study was retrospective in design and included 111 eyes that had already undergone uncomplicated cataract surgery with implantation of either a ReSTOR+3 or a ReSTOR+4 lens (Alcon Laboratories, Fort Worth, Texas, USA). All patients within the study group were aged between 60 and 80 years old. There were two groups in total.

The first (Group A) consisted of 51 eyes that had been operated on between 2005 and 2008. Only dilated fundoscopy was used for this group's pre-op assessment as OCT was not available at that time. While the second group (Group B), comprising 60 eyes, were operated on later (2008–2010) and so had both OCT and dilated fundoscopy as part of their cataract pre-op assessment. "As expected," said Dr Patsoura, "the first group had a longer follow up than the second group." All patients' maculas were imaged using OCT during their last follow up visit.

Results

Dr Patsoura explained that in terms of corrected distance and near visual acuity (VA) Group A did relatively well, however, she was surprised at the number of eyes with maculopathy during the follow up. The main problems encountered were macular degeneration (AMD) and epiretinal membranes (ERM).

"The percentage of maculopathy in this group was comparable to the prevalence of these issues in the general population, so we concluded that our exclusion criteria were not strict enough," she surmised. In looking at Group B, the physicians saw more improvement in best-corrected near and distance VA. Fewer patients in the group had maculopathy changes. Group B was expected to be doing much better in the long-term as they had less risk of developing severe macular changes because of the OCT in the pre-op assessment enabling better patient selection.

"How can this change our practice?" questioned Dr Patsoura. "We now know that we need to exclude patients with even minor macular changes from having a MIOL implantation. When it comes to patients with a healthy retina but who have diabetes or a strong family history of macular degeneration, they must be informed that a lens exchange may be needed in the future if a macular condition develops."

Dr Patsoura has no financial interests in the subject matter of this piece.