Abstract
Purpose :
In the pre-operative assessment of patients with cataract, careful assessment of the macula is critical. Yet for even the most experienced examiner, macular pathology can be missed on routine fundus exam. For this reason, practitioners obtain optical coherence tomography (OCT) of the macula on a routine or case by case basis. However, little data exists to guide clinicians regarding the utilization of OCT in the pre-operative assessment of these patients. In this study we investigate the rate of macular pathology as detected by clinical examination and by OCT testing in a population of patients undergoing pre-operative assessment for cataract surgery.
Methods :
This retrospective study included 477 patients undergoing assessment for cataract surgery at a comprehensive ophthalmology practice in the United States. Pre-operative evaluation was performed by one of two surgeons and included a medical and ocular history, best corrected visual acuity, and a thorough slit lamp and dilated fundus examination. All patients underwent macular OCT testing through a dilated pupil (Cirrus OCT, Carl Zeiss Meditec, Dublin, CA). OCT images were reviewed for quality and macular findings.
Results :
At the time of pre-operative evaluation, average patient age was 71 yrs, 56% were female, 23% were diabetic, 11% had hypertension, 19% were new patients, and 89% were ultimately scheduled for cataract surgery. Average best corrected visual acuity was 20/50 (Snellen).
In total, 64 (14%) carried a prior macular diagnosis. In 72 patients (16%), a new macular diagnosis was made by clinical exam alone. In 25 patients (5.4%) a new macular diagnosis was made by OCT that was not detected clinically; these diagnoses included diabetic macular edema (n=7), macular pucker (n=7), macular hole or pseudohole (n=4), nonexudative macular degeneration (n=3), exudative macular degeneration (n=1), and vitreomacular traction (n=1).
Conclusions :
We find that macular OCT offers improved sensitivity over clinical examination alone in diagnosing macular pathology in the pre-operative assessment of patients with cataract. Accurate pre-operative macular diagnosis may result in improved informed consent for surgery, intraocular lens selection, pre-operative planning, and postoperative care. Benefits of pre-operative OCT testing must be considered with respect to cost and resource management.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.