To assess the prevalence of macular abnormalities identified only on macular optical coherence tomography (OCT) which were not suspected by biomicroscopic fundus examination, and examine the clinical outcome of patients with these macular abnormalities during preoperative evaluation for cataract surgery in a large series of Korean patients.
Macular OCT was performed on patients scheduled for routine cataract surgery by the same physician at Seoul St. Mary’s Hospital, between June 2018 and November 2019. The patients’ medical records were reviewed retrospectively to obtain demographic data and the results of preoperative evaluation before cataract surgery. Patients were divided into two groups based on the preoperative macular OCT results: normal and abnormal OCT groups.
Nine hundred eighty-seven eyes (698 patients) were included in this study. Macular OCT identified abnormalities in 44 eyes (4.5%) of 35 patients (5.0%). Twenty-one eyes (2.1%) had age-related macular degeneration, 20 eyes (2.0%) had epiretinal membrane, and three eyes (0.3%) had lamellar hole. Patients with macular abnormalities identified on macular OCT had a statistically significant higher mean age than those who had normal OCT findings (
In the preoperative evaluation for cataract surgery in Korean patients, one in every 20 patients had macular abnormalities identified only on macular OCT in spite of unremarkable macular findings on biomicroscopic funduscopy. Age was significantly higher in patients with abnormal macular OCT findings. Thus, inclusion of macular OCT examination in preoperative screening before routine cataract surgery would be beneficial.
Cataract is a common cause for vision loss worldwide leading to cataract surgery as one of the most commonly performed clinical procedure in the medical field [
Historically, a dilated biomicroscopic fundus examination was the standard screening method for preoperative evaluation of cataract surgery, but it remains a challenge in the presence of media opacities. Now, optical coherence tomography (OCT) is used commonly as a noninvasive and sensitive test for the evaluation of macular structure [
Prior studies reported that in 7.2% to 54.2% of patients, macular pathology was identified on OCT during preoperative evaluation for cataract surgery [
This study included patients who were scheduled for cataract surgery by the same physician (SHC) at Seoul St. Mary’s Hospital (Seoul, Korea), between June 2018 and November 2019. Excluded were eyes with a previous diagnosis of macular disease, eyes with precluded funduscopy or macular OCT examination due to media opacity, and eyes with a suspicious biomicroscopic fundus examination. The study followed the tenets of the Declaration of Helsinki. Approval was obtained from the institutional review board of the Seoul St. Mary’s Hospital, The Catholic University of Korea (2020-1362-0002). Written informed consent was waived due to the retrospective nature of the study.
The patients’ medical records were reviewed retrospectively to obtain demographic data and the results of preoperative evaluation. Preoperative evaluation included slit-lamp biomicroscopy to assess the anterior segment, dilated biomicroscopic fundus examination, optical biometry, corneal topography, specular microscopy, and macular OCT. Biomicroscopic fundus examination was done by a retinal specialist. Macular OCT was performed using a Swept-Domain OCT device (Heidelberg Spectralis; Heildelberg Engineering, Heidelberg, Germany) or a Swept-Source OCT device (DRI Triton; Topcon, Tokyo, Japan) by an experienced operator. The scans were also reviewed by a retinal specialist.
Statistical analysis was performed using IBM SPSS Statistics ver. 22.0 (IBM Corp., Armonk, NY, USA). Categorical variables are expressed as absolute and relative frequencies. Continuous variables are expressed as the mean ± standard deviation (95% confidence intervals). The Mann-Whitney
Of the 799 patients (1,126 eyes) scheduled for routine cataract surgery, 48 patients (59 eyes) were excluded owing to previously diagnosed macular abnormality, 29 patients (38 eyes) were excluded owing to precluded funduscopy or macular OCT examination, and 24 patients (42 eyes) were excluded owing to suspicious biomicroscopic funduscopic findings. Thus, 698 patients (987 eyes) were included in this study (
The mean age of the patients was 66.3 ± 11.1 years. Of the patients, 410 patients (58.7%) were women, 131 (18.8%) had diabetes, 198 (28.5%) had hypertension, 24 (3.4%) had heart disease, and 16 (2.3%) had cerebrovascular disease (
Of the 698 patients (987 eyes) included in this study, 663 patients (943 eyes) had normal OCT and 35 patients (44 eyes) had abnormal OCT findings in at least one eye (
Demographic data of patients with a normal macular OCT and those with an abnormal macular OCT were compared. Patients with macular abnormalities identified only on macular OCT had a statistically significant higher mean age than those who had a normal macular OCT (
The visual acuity was also compared between the two groups. Uncorrected visual acuity (UCVA) before cataract surgery was significantly worse in patients with abnormal macular OCT (
As the technology developed in the field of cataract surgery, the accessibility and expectancy for cataract surgery has increased throughout the decade [
Macular abnormalities identified only on macular OCT account for 5.0% of patients in this study. It means that one in every 20 patients scheduled for routine cataract surgery, might have had an undiagnosed macular abnormality if the preoperative macular screening was performed exclusively by biomicroscopic fundus examination. Similarly, Pinto et al. [
We also compared the demographic data of patients according to their macular OCT examination, and found out that the patients’ mean age was statistically higher in those with occult macular diseases. As the patients get older, the prevalence of abnormal macular OCT seems to increase. The other variables we studied did not show a statistically significant correlation with macular diseases. Our results agrees with those of Pinto et al. [
The clinical significance of preoperative macular OCT was examined by comparing visual outcomes between the normal and abnormal macular OCT groups. Patients with abnormal macular OCT showed worse UCVA and BCVA after surgery. Therefore, we can expect that patients with abnormal macular OCT results in preoperative examination would have a worse visual outcome after surgery, and can inform the patient beforehand about the visual prognosis.
To summarize, in the preoperative examination for routine cataract surgery in a large series of Korean patients, one in every 20 patients had macular abnormalities identified on macular OCT in spite of unremarkable findings on biomicroscopic funduscopy. Age was significantly higher in patients with abnormal macular OCT findings. Moreover, patients with abnormalities in macular OCT showed worse visual outcomes after cataract surgery. Therefore, macular OCT is considered to be a sensitive tool in screening preoperative patients scheduled for routine cataract surgery than undergoing biomicroscopic funduscopy alone, especially in patients over the age of 70. Preoperative macular OCT can be also beneficial in terms of efficacy and safety by predicting and informing the patients beforehand about their visual outcomes. In conclusion, preoperative screening for macular diseases by not only biomicroscopic funduscopy but also by macular OCT allows patients undergoing and surgeons preforming cataract surgery to understand the visual prognosis and to receive and provide individualized counseling.
No potential conflict of interest relevant to this article was reported.
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2020R1A2B5B 01002407).
Screening of patients scheduled to undergo routine cataract surgery. OCT = optical coherence tomography.
Macular optical coherence tomography showing (A) age-related macular degeneration, (B) epiretinal membrane, and (C) lamellar hole. Fundus photo showing (D) age-related macular degeneration, (E) epiretinal membrane, and (F) lamellar hole.
Age stratified prevalence of abnormal macular optical coherence tomography (OCT) before routine cataract surgery.
Basic demographic data
Characteristics | Value |
---|---|
Female | 410 (58.7) |
Age (yr) | 66.3 ± 11.1 |
Diabetes | 131 (18.8) |
Hypertension | 198 (28.5) |
Heart disease | 24 (3.4) |
Cerebrovascular disease | 16 (2.3) |
Values are presented as number (%) or mean
Macular abnormalities identified only on macular optical coherence tomography with unremarkable macular findings on funduscopy
Abnormality | Patient | Eye |
---|---|---|
Age-related macular degeneration | 17 (2.4) | 21 (2.1) |
Epiretinal membrane | 16 (2.3) | 20 (2.0) |
Lamellar hole | 2 (0.3) | 3 (0.3) |
Total | 35 (5.0) | 44 (4.5) |
Values are presented as number (%).
Comparison of the demographic data of patients with normal and abnormal macular OCT
Characteristics | Normal OCT (663 patients) | Abnormal OCT (35 patients) | Multivariate logistic regression | |||
---|---|---|---|---|---|---|
| ||||||
OR | 95% CI | |||||
Female | 391 (59.0) | 19 (54.3) | 0.402 | 0.67 | 0.33–1.37 | 0.282 |
Age (yr) | 66.0 ± 11.1 | 72.5 ± 9.4 | <0.001 |
1.08 | 1.03–1.12 | 0.001 |
Diabetes | 122 (18.4) | 9 (25.7) | 0.397 | 1.14 | 0.49–2.67 | 0.670 |
Hypertension | 184 (27.8) | 14 (40.0) | 0.154 | 1.20 | 0.56–2.58 | 0.692 |
Heart disease | 23 (3.5) | 1 (2.9) | 0.888 | 0.51 | 0.06–4.01 | 0.601 |
Cerebrovascular disease | 15 (2.3) | 1 (2.9) | 0.778 | 0.88 | 0.11–7.08 | 0.888 |
Values are presented as number (%) or mean ± standard deviation.
OCT = optical coherence tomography; OR = odds ratio; CI = confidence interval.
Mann-Whitney test, otherwise chi-square test;
Preoperative and postoperative visual acuity of patients with normal and abnormal macular OCT
Normal OCT (943 eyes) | Abnormal OCT (44 eyes) | ||
---|---|---|---|
UCVA (logMAR) | |||
Preoperative | 0.44 ± 0.37 | 0.52 ± 0.37 | 0.022 |
Postoperative | 0.12 ± 0.20 | 0.24 ± 0.24 | <0.001 |
|
<0.001 |
<0.001 |
|
Preoperative - postoperative | 0.32 ± 0.32 | 0.28 ± 0.31 | 0.180 |
BCVA (logMAR) | |||
Preoperative | 0.41 ± 0.34 | 0.37 ± 0.30 | 0.745 |
Postoperative | 0.11 ± 0.18 | 0.16 ± 0.21 | 0.048 |
|
<0.001 |
<0.001 |
|
Preoperative - postoperative | 0.30 ± 0.30 | 0.21 ± 0.19 | 0.054 |
Values are presented as mean ± standard deviation.
OCT = optical coherence tomography; UCVA = uncorrected visual acuity; logMAR = logarithm of the minimum angle of resolution; BCVA = best-corrected visual acuity.
Mann-Whitney test;
Wilcoxon signed rank test.