Utility of Macular Optical Coherence Tomography in a Resident Clinic

Abstract

Purpose: : To evaluate the utility of macular optical coherence tomography (OCT) ordered by ophthalmology residents.

Methods: : Macular OCTs ordered by ophthalmology residents from December 2006 to November 2007 and corresponding patient medical records were retrospectively reviewed. Data compiled from patient records included the pre-OCT clinical diagnosis, OCT interpretation by one retina attending, and post-graduate year of the examining resident. Regression analysis was used to compare correlations between: 1) pre-OCT clinical diagnosis and OCT diagnosis and 2) post-graduate resident year and frequency of correct diagnosis based upon OCT results.

Results: : Macular OCTs were performed on 161 eyes of 103 patients. Pre-OCT diagnoses included diabetic macular edema (DME, 58 eyes, 36.0%), pseudophakic post-operative cystoid macular edema (CME , 32 eyes, 19.9%), epiretinal membrane (14 eyes, 8.7%), uveitic CME (13 eyes, 8.1%), suspected macular edema as cause of visual loss (13 eyes, 8.1%), venous occlusion with macular edema (10 eyes, 6.2%), macular hole (7 eyes, 4.3%), age-related macular degeneration (AMD, 6 eyes, 3.7%), and other (8 eyes, 5.0%). OCT confirmed the pre-OCT clinical diagnosis in 91 of 161 (56.5%) patients. Agreement between OCT and clinical diagnosis was high for uveitic CME (100%), venous occlusion with macular edema (90.0%), and macular hole (71.4%). Agreement between OCT and clinical diagnosis was low for pseudophakic CME (40.6%) and suspected macular edema as cause of visual loss (15.4%). The overall positive agreement between clinical diagnosis and OCT diagnosis did not vary significantly by resident year (r²=0.216): 55.3% for first-year residents (n=38), 58.6% for second-year residents (n=29), and 56.4% for third-year residents (n=94).

Conclusions: : In a resident clinic, macular OCT confirmed the pre-OCT clinical diagnoses most often in cases of macular edema and macular hole. The OCT was useful in ruling out macular edema as the cause of visual loss in 60% of pseudophakic patients with decreased vision and in 83% of patients with vision loss of unknown etiology. Overall, in nearly 50% of cases, OCT diagnosis contradicted the pre-OCT clinical diagnosis (p<.05), often leading to a change in patient management.

Keywords: imaging/image analysis: clinical • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • macula/fovea