Pre cataract surgery macular ocular coherence tomography: detecting ocular co morbidities and managing patient expectations

OCT to identify macular changes not clinically detectable in elderly patients with cataract

“…5,6,8,11 In view of the high rate of aging in the Brazilian population and the high operational costs associated with OCT, the objective of this study was to evaluate the relevance of this technique, principally in the population older than 60 years for whom the benefit of its use could justify the cost. 4 The mean age of the participants in this study was 70.9 ± 6.8 years (range 60 to 92 years), with the mean age in the group with abnormalities on OCT being 74.4 ± 6.3 years compared with 70.4 ± 6.7 years in the group without abnormalities. Pinto et al reported a prevalence of macular disease detected only on OCT of 7.2% in a study in which the mean age of patients was 67.4 ± 8.7 years (range 24 to 90 years), with a mean age of 71.2 ± 7.8 years in those with abnormalities detected on OCT compared with 67.1 ± 8.7 years in those with no abnormalities.…”

“…[1][2][3]12 On the other hand, the results from all the studies show the high effectiveness of OCT for the detection of macular disease not identified at clinical examination and highlight the importance of the examination in the preoperative evaluation for cataract surgery. [1][2][3][4][5][6]9,12 There are still other advantages of preoperative OCT, such as the fact that some patients may develop ERM after cataract surgery, and an image documenting its absence in the preoperative evaluation plays an important role in the patient's history. 11 In addition, the identification of an attached hyaloid preoperatively can be better counseled by the cataract surgeon.…”

“…2 Nonetheless, some studies have shown that the presence of mild macular disease concomitant with intense media opacity could be overlooked, constituting an important limitation of these techniques. [2][3][4] In the elderly population (those aged older than 60 years according to the World Health Organization), the limitations of indirect ophthalmoscopy are compounded by the greater prevalence of retinal diseases in that age group leading the ophthalmologist to make inappropriate decisions and the patient to create unrealistic expectations. [4][5][6] Current projections of the Brazilian Institute of Geography and Statistics indicate an expressive increase in the elderly population in Brazil in coming decades, which is in agreement with the high rate of aging already seen in specific regions throughout the country.…”

“…5 In this scenario, optical coherence tomography (OCT) is a noncontact, noninvasive, safe, and rapid imaging technique that allows detailed visualization of the macular structures. 4,5 As part of the spectrum of preoperative tests for cataract surgery, OCT has been used to identify mild macular disease, guiding surgical planning and optimizing the outcome of surgery to meet the expectations of both the ophthalmologist and the patient. [2][3][4][5] The primary objective of this study was to demonstrate the importance of OCT in identifying macular abnormalities that were not detected at the preoperative clinical examination for cataract surgery in patients older than 60 years.…”

“…2 Nonetheless, some studies have shown that the presence of mild macular disease concomitant with intense media opacity could be overlooked, constituting an important limitation of these techniques. 2–4…”