Patient Management Modifications in Cataract Surgery Candidates Following Incorporation of Routine Preoperative Macular optical coherence tomography

Purpose: To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery.

Setting: Shaare-Zedek Medical Center, Jerusalem, Israel.

Design: Retrospective case-series.

Methods: Consecutive patients, 50 years-of-age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning prior to cataract surgery. The scans were reviewed by a retina specialist for macular pathology and compared to preoperative biomicroscopic fundus examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed.

Results: Four-hundred and fifty-three eyes of 453 patients were enrolled in the study; 42 (9.2%) eyes were excluded due to noninterpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 (40.6%) eyes, including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 (26.0%) patients was modified due to macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopy examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes, 17.8%) and referral to a retina specialist for consultation (34 eyes, 8.3%).

Conclusions: Routine macular SD-OCT scans for cataract surgery candidates helped to identify macular pathologies that might be missed or underestimated by standard fundus biomicroscopy examination. The added information could improve patient management.