Eyeworld

16 | EYEWORLD | MARCH 2021 by Jennifer Nadelmann, MD, Daniel Choi, MD, Diana Kim, MD, Dario Marangoni, MD, Zujaja Tauqeer, MD, and Paul Tapino, MD is not currently the standard of care for cataract surgery candidates who are not considering premium IOLs. 2 Summary The authors reported on a large retrospective case series that took place between November 2017 and January 2018 at the Shaare Zedek Medical Center in Jerusalem, Israel, a large tertiary care center. Patients were included if they had senile cataracts scheduled for cata- ract extraction, were at least 50 years of age or older, and had a SD-OCT (SPECTRALIS, Heidelberg Engineering) scan prior to surgery. A single retinal specialist reviewed the scans to diagnose macular pathologies and to determine whether patients should be referred to a retinal specialist. The retinal specialist was blinded to the patients' medical records and exam findings. The OCT interpretation was then compared to the preoperative fundus exam to determine the rate of missed and underestimated macular pathologies. Missed macular pathologies were defined as those that were detected by SD-OCT but not by fundus exam. Underestimated macu- lar pathologies were those that were originally detected by fundus exam but had not been con- sidered clinically significant enough to neces- sitate further assessment by a retinal specialist prior to obtaining the SD-OCT. The authors also measured factors associated with higher rates of macular pathologies including age, gender, and diabetes mellitus. The authors reviewed chang- es in management, which they defined as any alteration to the preoperative process as a result of the macular SD-OCT. 4 There were 453 eyes originally enrolled in the study, 42 (9.2%) of which were excluded due to having non-interpretable scans because of advanced cataract. Macular pathologies were detected by SD-OCT in 167/411 eyes (40.6%). There were 12 eyes that had more than one condition that was detected on SD-OCT. The most common diseases diagnosed were age-re- lated macular degeneration (AMD) in 50%, epiretinal membrane (ERM) in 28.3%, and cystoid macular edema (CME) in 12.8% of eyes. Of note, patients with macular pathologies were found to be older (77.4 vs. 72.4 years, ASCRS/EYEWORLD JOURNAL CLUB ASCRS NEWS Review of "Patient management candidates following incorporation of T he preoperative assessment for pa- tients considering cataract surgery currently includes dilated fundus biomicroscopy in order to identify underlying retinal conditions. 1,2 The identification of retinal pathologies in patients considering cataract surgery is essential because it affects surgical planning, clinical decision- making, surgical outcomes, and helps guide the informed consent process and patient expec- tations. 1,2,3 Specifically, cataract surgery candi- dates with retinal pathologies that are visually significant can be referred to a retinal specialist to determine whether they require treatment for the retinal condition, such as a combined cata- ract-retinal surgery or intraoperative injection, or stabilization of the retinal pathology prior to proceeding with cataract extraction. In patients with dense lens opacities, the fundus exam may be limited, which may lead to inability to diagnose clinically significant retinal diseases. 2 Optical coherence tomography (OCT) is a quick and non-invasive imaging modality that has a high sensitivity in diagnosing macular condi- tions and is often utilized in patients consid- ering advanced technology intraocular lenses (IOLs). 3 The use of SD (spectral-domain) OCT THE ASCRS Journal Club is a virtual, compli- mentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the January session featured a presentation by Riccardo Vinciguerra, MD, lead author of "Evaluating keratoconus progression prior to crosslink- ing: Kmax versus the ABCD grading system." The second manuscript, "Patient manage- ment modifications in cataract surgery can- didates following incorporation of routine preoperative macular OCT," was presented by Jennifer Nadelmann, MD, resident, Scheie Eye Institute, University of Pennsylvania. To view the January Journal Club session, visit: https://ascrs.org/clinical-education/ journal-club/schedule/january-2021. Jennifer Nadelmann, MD Resident Scheie Eye Institute University of Pennsylvania Philadelphia, Pennsylvania Paul Tapino, MD Residency Program Director Scheie Eye Institute University of Pennsylvania Philadelphia, Pennsylvania

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