Incorporating Optical Coherence Tomography in the Cataract Preoperative Armamentarium: Additional Need or Additional Burden?

PURPOSE: To determine the usefulness of preoperative OCT examination to detect asymptomatic macular abnormalities in patients scheduled for cataract surgery METHODS: Design: Prospective, interventional case series Setting: Iladevi Cataract and Visakha Eye Center, Ahmedabad, IndiaStudy Population: Patients undergoing cataract surgery and intraocular lens(IOL) implantation for senile cataracts. Preoperatively no retinal/macular pathology was identified on clinical evaluation.

INTERVENTION: All eyes underwent Macular 5-Line Raster evaluation using Spectral Domain OCT before and after cataract surgery(monthly for 3 months). Central Subfield Thickness(CST) analysis was done.

OUTCOME MEASURES: The primary outcome measure was determining the incidence of asymptomatic retinal lesions on OCT examination in clinically 'normal' maculas. Secondary outcome measures included documenting change in CDVA and OCT thickness postoperatively.

RESULTS: 1444 eyes were evaluated. OCT revealed asymptomatic lesions in 133(9.21%) patients. At 3 months, all eyes showed significant median visual improvement(from 0.45 + 0.13 LogMAR to 0.06 ± 0.08 LogMAR; P=0.015) and insignificant median CST change(from 223.34+ 21.1μ to 249.12±19.24μ; P=0.19). One eye showed increased VMT(3 months). Patients with asymptomatic lesions did not have significantly worse postoperative visual outcomes at 3 months (from 0.52 + 0.16 LogMAR to 0.14 +0.1 LogMAR; P=0.12).

CONCLUSION: 9.21% patients with clinically normal maculas had subtle pathology detected on OCT but this subset of patients did not have worse postoperative visual outcomes compared to eyes with normal OCT scans. Thus, a careful pre-cataract surgery fundus examination remains an essential part of the pre-surgical patient evaluation.