Eyeworld

18 | EYEWORLD | MARCH 2021 Contact Nadelmann: Jennifer.Nadelmann@ pennmedicine.upenn.edu Tapino: Paul.Tapino@ pennmedicine.upenn.edu ASCRS NEWS Patient management modifications in cataract surgery candidates following incorporation of routine preoperative macular OCT Yishay Weill, MD, Joel Hanhart, MD, David Zadok, MD, David Smadja, MD, Evgeny Gelman, MD, Adi Abulafia, MD J Cataract Refract Surg. 2021;47(1):78–82. n Purpose: To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery. n Setting: Shaare Zedek Medical Center, Jerusalem, Israel. n Design: Retrospective case series. n Methods: Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning prior to cataract surgery. The scans were reviewed by a retina specialist for macular pathology and compared to preoperative biomicroscopic fundus examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed. n Results: Four-hundred and fifty-three eyes of 453 patients were enrolled in the study. Forty-two (9.2%) eyes were excluded due to non-interpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 (40.6%) eyes, including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 (26.0%) patients was modified due to macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopy examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes, 17.8%) and referral to a retina specialist for consultation (34 eyes, 8.3%). n Conclusion: Routine macular SD-OCT scans for cataract surgery candidates help to identify macular pathologies that may be missed or underestimated by standard fundus biomicroscopy examination. The added information can improve patient management. continued from page 17 study, nearly 1 in 10 scans were excluded due to being non-interpretable secondary to advanced cataract. Another limitation of this study is that it did not exclude patients who had previously diagnosed macular pathologies. In addition, the study took place at a large tertiary care cen- ter with several older patients with advanced cataracts, many of whom had other concomitant systemic and ophthalmic conditions. Finally, the study did not report on or compare the postop- erative visual acuity and change in vision in pa- tients who had macular pathologies caught on SD-OCT compared to those with normal scans. Leung et al. showed that a preoperative OCT added to the costs of cataract surgery in a patient considering a multifocal IOL but im- proved the quality-adjusted life years (QALYs) over time by increasing the detection of macu- lar pathologies. 13 Further studies are indicated to evaluate the cost effectiveness of the use of macular SD-OCT scans prior to routine cataract surgery. Conclusion Overall, this study retrospectively evaluated the utility of macular SD-OCT scans in routine preoperative assessment for cataract surgery. In this study, SD-OCT improved detection of macu- lar pathologies that had been missed or under- estimated by fundus exam, leading to clinical management changes prior to cataract surgery with respect to intraocular lens selection as well as retinal consultation. Additional studies are needed to measure the cost effectiveness of obtaining SD-OCT prior to routine cataract surgery. References (cont.) 8. Huang X, et al. Macular assessment of preoperative optical coherence tomography in ageing Chinese undergoing routine cataract surgery. Sci Rep. 2018;8:5103. 9. Kowallick A, et al. Optical co- herence tomography findings in patients prior to cataract surgery regarded as unremarkable with ophthalmoscopy. PLoS One. 2018;13:e0208980. 10. Pinto WP, et al. Prevalence of macular abnormalities iden- tified only by optical coherence tomography in Brazilian patients with cataract. J Cataract Refract Surg. 2019;45:915–918. 11. Sudhalkar A, et al. Incorporat- ing optical coherence tomogra- phy in the cataract preoperative armamentarium: Additional need or additional burden? Am J Ophthalmol. 2019;198:209–214. 12. Zafar S, et al. Swept-source optical coherence tomography to screen for macular pathology in eyes having routine cataract surgery. J Cataract Refract Surg. 2017;43:324–327. 13. Leung EH, et al. Cost-effec- tiveness of preoperative OCT in cataract evaluation for multifo- cal intraocular lens. Ophthalmol- ogy. 2020;127:859–865.

• Blank Page
• Blank Page (1)