Optical Coherence Tomography: Critical Tool to Manage Expectations after Cataract Extraction
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RETINA (R GOLDHARDT, SECTION EDITOR)
Optical Coherence Tomography: Critical Tool to Manage Expectations after Cataract Extraction Raquel Goldhardt 1 & Bradley Simon Rosen 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review evidence on the utility of spectral domain optical coherence tomography (SD-OCT) in evaluating retinal structure prior cataract surgery and highlight new technologies that can assess retinal function perioperatively. Recent Findings SD-OCT detected clinically unsuspected macular pathology in 4.6–25% of individuals in the pre-operative cataract evaluation. The most common findings were epiretinal membrane and macular degeneration with frequencies that varied by population studied. These conditions have been associated with complication after surgery (e.g., macular edema, visual dissatisfaction). As such, findings on SD-OCT may impact the informed consent process, alter IOL selection, and provide realistic post-operative vision expectations. Other technologies that assess retinal function, such as microperimetry and multifocal ERG are beginning to be studied but their utility in the pre-operative cataract evaluation is not yet known. Summary SD-OCT should be incorporated as a routine test prior to surgery to manage patient expectations and assist with optimal IOL selection, as even individuals with a seemingly normal clinical exam may have macular pathology. SD-OCT is the most established method for evaluating retinal anatomy and offers the benefits of a reduction in cases with missed macular pathology and fewer post-operative visual surprises. Keywords Cataract surgery . Multifocal intraocular lenses . Optical coherence tomography . Pre-operative evaluation . Patient expectations . Macula pathology
Introduction There is no single test or measure that can capture and separate the effect of a cataract on a patient’s visual status or functional ability. Nonetheless much of the perceived success of cataract surgery depends on accurate pre-operative patient counseling, testing, and biometric measurements. Missed retinal pathology is one of the causes of disappointing visual results [1, 2], and preventable patient dismay associated with a technically successful cataract procedure.
This article is part of the Topical Collection on Retina * Raquel Goldhardt [email protected] 1
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
2
Private Practice, Los Angeles, CA 90292, USA
Patient expectations are at all-time highs. New technologies including multifocal intraocular lenses (IOLs), intraoperative aberrometry, IOL formulas, and femtosecond lasers by and large allow surgeons to deliver on the heightened expectations. Missed retinal pathology, however, can lead to unpleasant visual surprises. Thus, it is critical for practitioners to make their best efforts to uncover retinal pathology prior to proceeding with cataract surgery. When found and dis
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