Welcome back to Interventional Mindset. In this episode, Preeya K. Gupta, MD, sits down with Elizabeth Yeu, MD, to discuss why they perform macular optical coherence tomography (OCT) imaging on all cataract patients.
Dr. Yeu is a fellowship-trained cornea, anterior segment, and refractive surgeon who is a partner at Virginia Eye Consultants. In addition, she is an assistant professor of ophthalmology at the Eastern Virginia Medical School in Norfolk, Virginia, and was the 2023/2024 President of the American Society of Cataract and Refractive Surgery (ASCRS).
Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.
Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.
Including OCT in routine pre-operative evaluations for cataract patients
Dr. Yeu noted that she considers macular OCT imaging to be a part of routine testing in pre-operative evaluations for all cataract patients, and not just reserved for premium intraocular lens (IOL) patients. She added that, in her opinion, similar to corneal topography, macular OCT has increasingly become a standard of care for anterior segment surgeons in pre-operative cataract evaluations.
In order to holistically understand the patient’s ocular health prior to cataract surgery, she includes diagnostic testing such as infrared meibography, macular OCT, and several corneal topographies into workups. She then takes this information into account when selecting IOLs and considers what other interventions the patient may require outside of cataract surgery to maintain or improve their ocular health.
Identifying AMD in cataract patients with OCT imaging
Using OCT imaging, surgeons can assess the foveal architecture and identify the presence of retinal disease, even when the foveal center and surrounding area appear normal on direct examination.1 For example, a 2022 study of 453 patients undergoing cataract surgery suggested that 41% of eyes demonstrated macular pathology, and 50% of these patients had age-related macular degeneration (AMD).2
Overall, the management of 107 patients (26.0%) was changed due to macular OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundoscopic examination.2 Drs. Gupta and Yeu emphasized how understanding the pathophysiology of common retinal diseases, such as AMD, allows surgeons to accurately address the patient’s visual symptoms and proactively educate them on available treatments.
Pearl: Dr. Gupta recommended reviewing OCT scans to rule out common pathologies, such as AMD, epiretinal membrane (ERM), and macular edema.
Referring cataract patients with AMD
As drusen and retinal pigment epithelium (RPE) changes are two hallmark findings associated with dry AMD,3 when Dr. Yeu sees cataract patients with both on macular OCT, she makes sure to ask whether they have received a previous diagnosis of AMD or GA. Depending on the response, she then considers referring the patient to a retina specialist for more targeted care.
When it comes to referring these patients to retina specialists, Dr. Gupta noted that although she will not manage the patient’s retinal disease, making the diagnosis is key to educating the patient, determining the next step in treatment, and choosing an optimal IOL.
Conclusion
With the recent development and approval of complement inhibition treatments for GA, Dr. Gupta explained that she feels compelled to refer AMD patients because there are now therapies available to intervene early in the disease process and slow the rate of vision loss.3
With an estimated 3.7 million cataract cases per year in the US,4 Dr. Yeu emphasized that anterior segment surgeons are very likely to encounter patients with concurrent AMD, and adding macular OCT to routine pre-operative cataract evaluations improves not only surgical outcomes but also GA screening.
