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B. M. Kim, J. I. Lim; Utility of Macular Optical Coherence Tomography in a Resident Clinic. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3226. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the utility of macular optical coherence tomography (OCT) ordered by ophthalmology residents.
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.
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).
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.
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