Eyeworld

EW CATARACT 68 March 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Presentation spotlight tion more difficult, and leaving the images blurry or blocked by cataract. The same is true for autofluorescence imaging. With these last two modal- ities, the more cataract there is, the more difficult it is to see the retina," he said. More good than harm Removing early cataract seems to make good sense in patients both with and without concomitant eye diseases. According to a study that investigated the risk–benefit relationship of performing cataract surgery in 128 eyes, three-quarters of eyes achieved visual acuity of greater than or equal to 6/12, and nearly two-thirds achieved emmetro- pia over the longer term (5 to 10 years). 1 Uncorrected refractive error and posterior capsule opacification were the main causes of poor vision in operated eyes. The study revealed that better visual acuity at baseline resulted in better visual acuity post- operatively. Interestingly, patients with fair or poor visual acuity at baseline showed no difference in their subjective feelings of visual improvement following cataract removal. Dr. Wolf felt that these outcomes supported the advantages of performing cataract surgery. "This seemed to indicate that even pa- tients with poor visual acuity benefit from cataract surgery. The take- home message here would be not to hesitate in doing cataract surgery in patients with poor visual acuity," Dr. Wolf said. retinal detachment, retinitis pig- mentosa, drusen-related macular degeneration, wet age-related macu- lar degeneration, Stargardt's disease, geographic atrophy, and eyes with a central scar. Of course, performing cataract surgery in these different patients is associated with different prognoses, but most patients would likely benefit from cataract surgery," Sebastian Wolf, MD, Department of Ophthalmology, University Hospital Bern, Bern, Switzerland, said in a presentation he gave during a clini- cal research symposium on cataract and macular disease. Diagnostics in patients with cataract and macular disease begin with the simple visual acuity exam and can include modalities such as ophthalmoscopy, OCT, fluorescein angiography, and autofluorescence imaging. Cataract, however, can compromise some of these examina- tions, as Dr. Wolf explained. "OCT, which uses infrared light, penetrates the lens and is uncompromised by even dense nuclear cataract. So, if there is a dense nuclear cataract, it will not affect diagnosis using in- frared light, and this is a very good feature of OCT. But, OCT cannot vi- sualize all parts of the retina. For the peripheral retina, we use ophthal- moscopy. Ophthalmoscopy can be compromised by cataract, however, which may directly block visibility. Fluorescein angiography is also dif- ficult in eyes with cataract because the blue light becomes absorbed by the yellow lens, making visualiza- Not just the macula Macular disease represents a larger composite of eye diseases in which the diagnostic evaluation of the macula but also the optic nerve and peripheral retina play a role. Many diseases of the retina need good light and visibility to be identified and studied. Eye doctors would agree that indirect ophthalmoscopy of the peripheral retina is challeng- ing enough without the added com- plication of lens opacities. As cata- ract formation largely begins along the outer borders of the lens, often densely opacifying this lens region, the diagnosis of retinal detachment and peripheral tears and holes in the retina can be overlooked. Although the macula may be easy to visualize if the patient's lens is clear at its center, the peripheral retina may not be as easy to see and diagnose. "If we talk about macular disease, we have to imagine this is a broad group of diseases including Cataract removal shown to be beneficial in patients with macular disease with reduced visual potential A ccording to a video presentation given at the XXXIV Congress of the ESCRS last year in Copenhagen, Denmark, eye surgeons should not hold back from removing cataracts in patients who show signs of macular disease. Comprehensive retinal evaluation necessitates extensive visualization of the posterior globe using available diagnostic modalities, which may be rendered useless by the presence of cataract. Although OCT can be used to visualize the macula and remain uncompromised by cataract, other diagnostic procedures may become blurred or blocked by cataract. Cataract surgery in patients with macular disease: Do not hesitate The European Society of Cataract and Refractive Surgeons (ESCRS) met in Copenhagen, Denmark in September 2016 " Ocular comorbidity may be important for patient expectations, but it should not change our minds about carrying out cataract surgery. " —Sebastian Wolf, MD

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