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T.Q. Pham, J.J. Wang, A. Maloof, P. Mitchell; Diagnostic Agreement in Ophthalmology Resident Assessment of Age–Related Maculopathy Lesions in Eyes Before and After Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3049.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: The risk of late age–related maculopathy (ARM) has been shown recently to be higher after cataract surgery. Correctly detecting ARM lesions preoperatively may assist the postoperative management of those who are at high risk of ARM progression. This study aims to assess the diagnostic precision in detecting ARM lesions preoperatively, when compared with the postoperative diagnosis. Methods: Consecutive cataract surgery patients attending a large public hospital in western Sydney, Australia, from July 2001 to June 2003 were included in this study. Pre– and 4–week post–operative documentation of ARM lesions was collected from medical records. Post–operative diagnosis was used as a gold standard. Sensitivities and specificities for the preoperative diagnosis of different types of ARM lesions (hard and soft drusen, hyper– and hypo–pigmentation of the retinal pigmented epithelium (RPE), geographic atrophy and neovascular lesions) were assessed using eye–specific data. Results: A total of 1014 cataract surgical procedures were performed during the 2–year period, including 878 among patients aged 60+ years. Eight hundred and twenty five eyes (94%) from 760 patients had data available for analysis. Of the 825 eyes, 117 (14.2%) were noted to have ARM lesions pre–operatively, including 16 (13.7%) with soft drusen, 25 (21.4%) with hard drusen, 50 (42.7%) with RPE changes, 3 (2.6%) with neovascular ARM and 8 (6.8%) with geographic atrophy. Postoperatively, the proportions in which a positive diagnosis was made for the corresponding lesions were 14.5%, 25.6%, 61.5%, 2.6%, and 6.8%, respectively. The sensitivities of preoperative reporting of neovascular ARM and geographic atrophy were both 100%; but were 94% for soft drusen, 83% for hard drusen and 69% for RPE changes, respectively. The specificities were 100% for neovascular ARM, geographic atrophy and soft drusen, 97% for hard drusen and 87% for RPE changes, respectively. Conclusions: Our data suggest that at this hospital, most cataract surgery was performed in not so dense lens opacities so that sensitivities and specificities for detecting the two late stages ARM lesions preoperatively were high. However, the sensitivities for detecting pre–operative RPE distrubance is relatively low, due to its more subtle appearance and presence of moderate dense cataract preventing a clear view of these subtle changes.
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