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Comment
. 2023 Mar;37(4):665-669.
doi: 10.1038/s41433-022-02027-0. Epub 2022 Mar 24.

Preoperative fundoscopy versus optical coherence tomography to detect occult maculopathy during cataract surgery preassessment

George Murphy  1 , Raisah Owasil  1 , Sam Kanavati  1 , Zahra Ashena  1 , Mayank A Nanavaty  2   3
Affiliations
Comment

Preoperative fundoscopy versus optical coherence tomography to detect occult maculopathy during cataract surgery preassessment

George Murphy et al. Eye (Lond). 2023 Mar.

Abstract

Purpose: To assess the proportion of maculopathy detectable only on optical coherence tomography (OCT) versus slit lamp indirect ophthalmoscopy (SLIO) during cataract assessment.

Methods: Population: Consecutive patients attending cataract assessments.

Data collection: All patients underwent OCT and SLIO. SLIO findings were recorded before reviewing OCT. Scans were examined to compare with recorded SLIO findings.

Primary outcome: analyse the proportion of eyes with maculopathy missed by SLIO.

Secondary outcome: to assess the proportion of patients with maculopathy on OCT, the incidence of maculopathy in the fellow eye on OCT and proportion with cataracts too dense to allow SLIO or OCT.

Results: Six hundred twenty-six patients were enroled. Eighty (12.8%) had maculopathy detectable only on OCT which included: 26 (4.2%) epiretinal membrane (ERM), 25 (4%) dry age-related macular degeneration (AMD), 19 (3%) vitreomacular traction (VMT), 5 (0.8%) lamellar macular hole (LMH), 2 (0.3%) cystoid macular oedema (CMO) and 1 (0.2%) wet AMD. 166 (26.5%) had maculopathy on OCT, of which only 48 (7.7%) had known history of maculopathy. In fellow eyes, 29 (4.6%) had significant findings and 29 (4.6%) were unable to have SLIO or OCT due to dense cataract.

Conclusions: A quarter of the patients had occult maculopathy. One-tenth of the occult maculopathy were missed without OCT, with ERM, dry AMD, VMT, LMH, CMO and wet AMD being the primary missed diagnosis. Less than 5% had occult maculopathy in fellow eye, and <5% had dense cataracts where neither SLIO nor OCT was not possible.

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Conflict of interest statement

None of the authors have any financial interest in any products or procedures mentioned in this study. Other unrelated disclosures are as below: GM: Lecture fee from Allergan, Ireland SK: Travel grant from Bayer. MAN: Research grants from Alcon Laboratories, USA; European Society of Cataract & Refractive Surgery; Johnson & Johnson, USA; Rayner Intraocular lenses, UK; Ziemer, Switzerland. Lecture fees from Alcon Laboratories, USA. Consultant to Hoya. Travel grants from Alcon Laboratories, USA & Bausch & Lomb, USA.

Figures

Fig. 1
Fig. 1. Presenting visual acuity.
Distribution of presenting visual acuity in referred eye.
Fig. 2
Fig. 2. Example cases of subtle OCT changes missed by slit lamp indirect ophthalmoscopy.
A Example of a case where epiretinal membrane was missed without OCT. B Example of a case where vitreomacular traction was missed without OCT. C Example of a case where mild dry age-related macular degeneration was missed without OCT. D Example of a case where lamellar macular hole was missed due without OCT.
See this image and copyright information in PMC

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References

    1. Hirnschall N, Leisser C, Radda S, Maedel S, Findl O. Macular disease detection with a swept-source optical coherence tomography-based biometry device in patients scheduled for cataract surgery. J Cataract Refract Surg. 2016;42:530–6. doi: 10.1016/j.jcrs.2016.02.029. - DOI - PubMed
    1. Klein BR, Brown EN, Casden RS. Preoperative macular spectral-domain optical coherence tomography in patients considering advanced-technology intraocular lenses for cataract surgery. J Cataract Refract Surg. 2016;42:537–41. doi: 10.1016/j.jcrs.2016.01.036. - DOI - PubMed
    1. Kraushar MF. Simplified binocular indirect ophthalmoscopy as a routine office procedure. Ann Ophthalmol. 1974;6:475–8. - PubMed
    1. Meuer SM, Myers CE, Klein BE, Swift MK, Huang Y, Gangaputra S, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography: the beaver dam eye study. Ophthalmology. 2015;122:787–95. doi: 10.1016/j.ophtha.2014.10.014. - DOI - PMC - PubMed
    1. Ng CH, Cheung N, Wang JJ, Islam AF, Kawasaki R, Meuer SM, et al. Prevalence and risk factors for epiretinal membranes in a multi-ethnic United States population. Ophthalmology. 2011;118:694–9. doi: 10.1016/j.ophtha.2010.08.009. - DOI - PMC - PubMed

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