Performing optical coherence tomography (OCT) as part of the pre-operative evaluation for all cataract surgery patients represents quality medical care and minimizes the potential for postoperative “visual surprises” leading to unhappy patients.
“Visual surprise is a term I coined to describe poor quality vision despite perfect surgery with a perfect refractive outcome,” Steve Charles, MD, said. “Minimizing the chances of a visual surprise requires OCT because it detects a variety of potentially treatable, vision-limiting macular pathologies that are absolutely invisible with a standard clinical examination.”
Dr. Charles, is founder, Charles Retina Institute, and clinical professor of ophthalmology, University of Tennessee, Memphis.
“Evaluation with OCT is 100% safe, has minimal labor cost, no consumables cost, and provides information that will allow better outcomes and realistic expectations,” Dr. Charles explained. “Recently, there has been an emphasis in cataract surgery on strategies for preventing refractive surprises to avoid patient dissatisfaction. However, surgeons need to avoid leaving patients with a visual surprise. By doing so, surgeons benefit because their patients, families, and the referring doctors will be happier.”
The pathologies that are uniquely identified with OCT include central serous retinopathy, transparent epimacular membranes, vitreomacular schisis, vitreomacular traction syndrome, and early wet age-related macular degeneration with subretinal fluid, a small area of choroidal neovascularization, and no hemorrhage. Although not all of the conditions need to be treated prior to cataract surgery, their presence informs appropriate surgical planning and patient counseling.
For example, optical biometry is mandatory for accurate axial length measurement in an eye with any of these conditions where ultrasound A-scan, which measures from the anterior retinal surface, is prone to error.
These macular conditions represent a relative contraindication to multifocal IOL implantation because the multifocal optics reduce contrast sensitivity. In addition, depending on the pathology that is present, patients may need to be told they will see better after cataract surgery, but they have a condition that will limit them from having perfect vision.