Screening for Occult Macular Pathology Prior to Cataract Surgery Using Optical Coherence Tomography

Abstract

Purpose: To study the prevalence of occult macular pathology using optical coherence tomography (OCT) during the preoperative evaluation for cataract surgery and associated risk factors. Methods: A retrospective analysis of patients' medical records and imaging. Adult patients who underwent cataract extraction who had normal preoperative fundoscopic examination and available preoperative OCT imaging were included. Results: The analysis included 121 eyes belonging to 121 patients. The prevalence of occult macular pathology was 21.5%, with the most common being interface abnormalities (8.3% of the eyes), drusen (4.1%), and diabetic macular edema (4.1%). Visually significant pathologies were noted in 6.6% of the eyes. Occult macular pathology was rare in patients aged less than 50 years (4.5%) and common among patients 70 years of age or older (43.3%). The most significant predictors of occult macular pathology were advanced age (OR: 1.06, p = 0.033) and diabetes mellitus (OR: 6.79, p = 0.002). Conclusion: Relying on fundoscopic evaluation alone would miss 1 in 5 eyes with occult macular pathology and 1 in 15 with pathologies that would alter the visual outcome. Preoperative OCT screening prior to cataract surgery should be considered, especially in patients with advanced age and diabetes mellitus.