Surgeon suggests using OCT for preop cataract evaluation to protect patient, physician

BUENOS AIRES — Using optical coherence tomography before cataract surgery can alert a surgeon to any underlying macular disease, allowing the surgeon to better prepare the patient, a surgeon said here.

Carmen A. Puliafito

"I think actually OCT's largest impact upon ophthalmology is a broad-range tool for comprehensive ophthalmologists," Carmen A. Puliafito, MD, MBA, said at the Argentinean Society of Ophthalmology Annual Course.

Specifically, he discussed how OCT can be used for preoperative evaluation of potential macular diseases.

"Macular disease is common in the cataract age range. Pre-existing retinal disease is a common reason for patient unhappiness [after cataract surgery]," he explained. "Clinical examinations can be misleading, and indeed, you don't see what you don't see or you most certainly don't see what you're not looking for or suspecting."

Dr. Puliafito, OSN U.S. Edition Retina/Vitreous Section Editor, showed various cases in which patients complained of visual loss that a surgeon might attribute to newly developed cataracts if he or she did not delve further into the eye to find the patient's underlying macular disease. Specifically, he pointed out that epiretinal membrane and vitreoretinal traction are difficult to diagnose clinically without the use of OCT.

"I have a recommendation, which is if you suspect macular pathology ... obtain an OCT," Dr. Puliafito said. "And if it is not perfect, you need to know it and the patient needs to know it. Both of you need to know it because you need to lower the patient's expectations for the cataract surgery."

This especially holds true, he said, for refractive cataract patients.

"These patients will be very unhappy if they do not have a perfect macula," Dr. Puliafito said.

So in addition to screening for suspicious pathologies, Dr. Puliafito warned surgeons to carefully examine all patients with good vision or those electing for refractive cataract surgery.

"This last point may be a little counterintuitive. The patients that need the most careful macular exam, the most careful scrutiny with OCT, are the patients with relatively good vision that you're considering operating on because they actually in many ways have the most to lose by the cataract operation," he explained.