Eyeworld

MARCH 2021 | EYEWORLD | 17 References 1. McKeague M, et al. Evaluation of the macula prior to cataract surgery. Curr Opin Ophthalmol. 2018;29:4–8. 2. Olson RJ, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2017;124:P1–119. 3. Klein BR, et al. Preoperative macular spectral-domain optical coherence tomog- raphy in patients consider- ing advanced-technology intraocular lenses for cataract surgery. J Cataract Refract Surg. 2016;42:537–541. 4. Weill Y, et al. Patient manage- ment modifications in cataract surgery candidates following incorporation of routine preop- erative macular OCT. J Cataract Refract Surg. 2021;47:78–82. 5. Abdelmassih Y, et al. Preoperative spectral-domain optical coherence tomography in patients having cataract surgery. J Cataract Refract Surg. 2018;44:610–614. 6. Enright NJ, et al. Yield of routine pre-cataract surgery macular optical coherence tomography in finding clinically undetected macular pathology. Clin Exp Ophthalmol. 2017;45:829–831. 7. Gallemore RP, et al. Diagnosis of vitreoretinal adhesions in macular disease with optical coherence tomography. Retina. 2000;20:115–120. surgery or may have been caused by the sur- gery. Therefore, the panelists thought that it was important to discuss concomitant retinal diseases with patients prior to proceeding with cataract surgery in order to appropriately set expectations and decrease the risk of patient dissatisfaction postoperatively. Especially in pa- tients with mature cataracts, an OCT scan is es- sential when the view to the fundus is obscured. Some challenges that were mentioned included that some ophthalmologists may not have an OCT capable machine in their office as well as concerns around reimbursement when ordering an OCT without a known diagnosis or indica- tion. In the setting of the current COVID-19 pandemic, the panelists also thought that the use of SD-OCT could enable a more focused examination. A significant limitation to the use of SD- OCT in routine preoperative cataract surgery screening for retinal pathology is that a dense cataract may itself prove a barrier to obtaining sufficient resolution on a macular scan. In this P<0.01) and had a higher incidence of diabetes mellitus (41.9% vs. 30.3%, P=0.02). Based on the SD-OCT findings, a change in management was undertaken in 107/411 eyes (26%), among whom 94/411 (22.8%) had macular pathologies missed, and 13/411 (3.2%) had pathologies underestimated based on fundus exam alone. Specifically, 73/411 patients (17.8%) were dis- couraged from presbyopia-correction solutions, and 34/411 patients (8.3%) were referred to a retina specialist. Among the patients who were referred to a retinal specialist, 15/34 proceed- ed with cataract surgery. Eleven underwent preoperative retinal treatment, four underwent a combined retinal surgery, one had an intraop- erative intravitreal injection, and three had their cataract surgery canceled. 4 Discussion This study showed that SD-OCT was more effective than fundus exam in detecting macular pathologies in patients scheduled for cataract surgery. In addition, the detection of subtle macular pathologies on SD-OCT led to a change in patient management in 26% of cases. Previ- ous studies have shown that posterior segment SD-OCT has a greater sensitivity to diagnose macular conditions than exam alone. 3,5–11 Studies have also shown that AMD and ERM are the most common pathologies detected by OCT. 3,5,10,12 The postoperative visual acuity fol- lowing cataract surgery is dependent on remain- ing refractive error, the implanted IOL, and the presence of ophthalmologic pathologies. There- fore, macular pathologies that may be visually significant should be diagnosed prior to cataract surgery to guide patient expectations. 1,2 Many of the cataract surgeons on the ASCRS Journal Club panel have been incorpo- rating OCT into their preoperative assessment for at least 3 years. An advantage of obtaining an OCT is that it helps educate patients on the presence of retinal conditions prior to making the decision to undergo cataract surgery. Now more than ever, patients expect to be free of glasses and contact lenses following cataract surgery. An unexpected retinal pathology that limits vision postoperatively can cause patient dissatisfaction and raise concerns that the pathology was missed on exam prior to the modifications in cataract surgery routine preoperative macular OCT" continued on page 18 PGY-3 ophthalmology class of Scheie Eye Institute residents Top: Zujaja Tauqeer, MD Middle from left: Diana Kim, MD, Jennifer Nadelmann, MD Bottom from left: Dario Marangoni, MD, Daniel Choi, MD Source: Scheie Eye Institute

• Blank Page
• Blank Page (1)