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Importance of macular Optical Coherence Tomography (OCT) scanning in Cataract assessment clinics

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First Author: G.Murphy UK

Co Author(s):    R. Owasil   Z. Ashena   S. Kanavati   M. Nanavaty           

Abstract Details

Purpose:

To investigate the prevalence of maculopathy discovered incidentally on OCT during routine cataract assessment clinics (CACs). Patient’s attending ophthalmic services for assessment of cataract may not routinely have an OCT scan of their retina, leading to subtle maculopathy only being discovered post-operatively when it has worsened. We sought to establish the prevalence of such maculopathy across 40 clinics to compare the OCT findings of these patients with the findings of fundoscopy alone.

Setting:

Cataract Assessment Clinics at the Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.

Methods:

A cross-sectional study of 626 consecutive patients attending cataract assessment clinics at the Sussex Eye Hospital between 2/11/20 and 6/11/20. Data on the eye that was referred for assessment, patient age, best corrected visual acuity (BCVA), known prior history of maculopathy, prior retinal surgery, and fundoscopic findings were collected at the time the patients were seen. An OCT scan of each patient’s macula was also performed and examined by a grader (GM) to compare with the findings from the clinic. The clinicians were asked not to look at the OCT scans whilst writing their examination findings.

Results:

Of 655 patients referred for cataract 626 attended and had data collected. 171 (27.3%) had 20/120 or worse vision in the referred eye. 68 (10.9%) were diabetic, only 1 was known to have macular oedema. 105 (16.8%) patients had subtle OCT findings not visible on fundoscopy by the clinician in the referred eye such as Vitreo-macular traction (VMT) (3%), Epiretinal Memberane (ERM) (4.5%), Cystoid Macular Oedema (CMO) (0.3%), Lamellar Hole (0.7%), Neovascular Macular Degeneration (0.1%). Incidental findings in the fellow eye only seen on OCT were also seen in 29 patients (4.6%) requiring further management.

Conclusions:

Many patients will have underlying maculopathy present when undergoing cataract surgery, which are not visible on fundoscopy alone. Knowledge of this underlying pathology will allow an improved consenting process and discussion with the patient regarding the risks, visual prognosis and recovery following cataract surgery. Incidental findings in the fellow eye would also allow for improved diagnosis and management of these patients without adding significant additional time to specialist high volume cataract assessment clinics. We propose macula OCT to be an essential tool in the armament of CACs.

Financial Disclosure:

... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented