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Kanda M, Malik M, Miller M, Deshmukh R. Poppers maculopathy missed in a patient with cataract highlights the importance of preoperative optical coherence tomography. BMJ Case Rep 2024; 17:e259477. [PMID: 38834306 DOI: 10.1136/bcr-2023-259477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Poppers maculopathy is a complication of alkyl nitrate (poppers) inhalation. It presents with non-specific symptoms and variable signs, which can make it difficult to diagnose. We present a case of coexisting cataract and poppers maculopathy in a patient. He had vague visual symptoms that were attributed entirely to his cataract and he went on to have cataract surgery. Suboptimal postoperative visual acuity and normal clinical examination triggered further investigation with spectral-domain optical coherence tomography (SD-OCT), after which poppers maculopathy was diagnosed. We highlight the importance of performing OCT in the preoperative assessment of a cataract patient, especially where the cataract is mild and may not fully account for symptoms. The patient showed complete visual recovery on drug cessation despite ongoing maculopathy on OCT scans.
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Affiliation(s)
- Mumta Kanda
- A&E, Cataract, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mohsan Malik
- Adnexal, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michael Miller
- Moorfields Private, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Rajesh Deshmukh
- Cataract, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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2
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Yeu E, Berdahl JP, Gupta PK, Patterson M. Sensitivity and specificity of SS-OCT for detecting macular pathologies vs SD-OCT. J Cataract Refract Surg 2024; 50:481-485. [PMID: 38192061 PMCID: PMC11045393 DOI: 10.1097/j.jcrs.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To evaluate the sensitivity and specificity of swept-source optical coherence tomography (SS-OCT) biometer compared with the gold standard spectral-domain optical coherence tomography (SD-OCT) for detecting macular pathology in patients with cataract. SETTING Eye Centers of Tennessee, Crossville, TN. DESIGN Prospective, cross-sectional, observational, examiner-masked. METHODS The study included 132 participants aged 50 years and older, who underwent precataract surgery work-up. All participants underwent fixation check retinal scans using SS-OCT biometer (IOLMaster 700) as well as full macular scans using Cirrus SD-OCT. 3 independent masked examiners evaluated the scans if they were normal or had a suspected pathology. Different measures of diagnostic accuracy were calculated for 3 examiners. RESULTS True positive rate (sensitivity) ranged from 71.1% (32/45) to 79.2% (42/53), and false negative rate was between 20.8% (11/53) and 28.9% (13/45) for the 3 examiners. True negative rate (specificity) ranged from 86.8% (59/68) to 94.1% (64/68), and false positive rate was between 5.9 (4/68) and 13.2% (9/68). The fitted receiver operating characteristic area ranged from 0.83 to 0.95. CONCLUSIONS Using retinal SS-OCT biometer scans as a replacement of the dedicated macular SD-OCT for screening or diagnosing macular health would not be appropriate because of its low sensitivity. SS-OCT biometer may potentially fail to identify approximately one-fourth of patients who actually have the disease. Therefore, the final decision on macular health should be based on the gold standard SD-OCT scans. When full macular SD-OCT scans are not accessible, the limited retinal scan information from SS-OCT biometer may still provide useful insights into the macular health.
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Affiliation(s)
- Elizabeth Yeu
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
| | - John P. Berdahl
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
| | - Preeya K. Gupta
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
| | - Michael Patterson
- From the Virginia Eye Consultants, Norfolk, Virginia (Yeu); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Triangle Eye Consultants, Raleigh, North Carolina (Gupta); Tulane University, New Orleans, Louisiana (Gupta); Eye Centers of Tennessee, Crossville and Cookeville, Tennessee (Patterson)
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Ahmed TM, Siddiqui MAR, Hussain B. Optical coherence tomography as a diagnostic intervention before cataract surgery-a review. Eye (Lond) 2023; 37:2176-2182. [PMID: 36517576 PMCID: PMC10366081 DOI: 10.1038/s41433-022-02320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/19/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to perform a systematic review of existing literature on OCT screening before cataract surgery. Available literature was evaluated and projections on how it could be applied to enhance postoperative outcomes of cataract surgery were summarised. The PubMed, Embase and Cochrane databases were searched for articles pertaining to preoperative OCT screening. Selected articles were qualitatively and quantitatively analysed. Across 9 studies, the addition of OCT macular screening resulted in preoperative detection of macular pathology in 13.7% of eyes that were determined to be normal on fundoscopic examination alone. The types of macular pathology most frequently detected through preoperative OCT screening were interface abnormalities followed by macular degeneration. Comparative analysis of SS-OCT biometer and SD-OCT found that SS-OCT had a sensitivity of 0.48-0.81 in the detection of macular pathology in eyes with pathology diagnosed by SD-OCT. OCT screening prior to cataract surgery results in the detection of occult macular pathology that may influence postoperative visual outcomes in approximately 1 in 10 eyes (13.7%). As a result, OCT screening should be considered in the routine preoperative workup for cataract surgery.
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Affiliation(s)
| | - M A Rehman Siddiqui
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan.
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Dos Santos BB, Ribeiro Junior MDLB, Garcia NP, Colombo Barboza GN, Colombo Barboza MN. OCT to identify macular changes not clinically detectable in elderly patients with cataract. J Cataract Refract Surg 2023; 49:711-715. [PMID: 36888557 DOI: 10.1097/j.jcrs.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To demonstrate the importance of optical coherence tomography (OCT) in identifying macular changes not detected at clinical examination preceding cataract surgery in patients older than 60 years. SETTING Hospital Oftalmológico Visão Laser, Santos, São Paulo, Brazil. DESING Prospective case series. METHODS Patients older than 60 years were selected for this cross-sectional prospective study conducted during preoperative examination for cataract surgery. Eyes with a previous diagnosis or clinical evidence of macular disease or with media opacity preventing OCT from being performed were excluded from the study. All the study participants underwent OCT and were then divided into 2 groups: patients with macular changes and patients without macular changes found on OCT. RESULTS Of 364 eyes screened (212 patients), 300 eyes (180 patients) were included in the study. OCT identified macular changes in 40 eyes (13.3%), with age-related macular degeneration being found in 13 eyes (4.3%), epiretinal membrane in 12 eyes (4%), intraretinal fluid in 12 eyes (4%), and macular hole in 3 eyes (1%). In the group with macular changes, the mean age was 74.4 ± 6.3 years compared with 70.4 ± 6.7 years for those without changes ( P < .001). CONCLUSIONS OCT proved an effective method for identifying macular diseases not detected at clinical evaluation before cataract surgery. Therefore, the relevance of performing OCT in these cases was confirmed and should be taken into consideration, particularly when evaluating patients older than 60 years.
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Murphy G, Owasil R, Kanavati S, Ashena Z, Nanavaty MA. Preoperative fundoscopy versus optical coherence tomography to detect occult maculopathy during cataract surgery preassessment. Eye (Lond) 2023; 37:665-669. [PMID: 35332291 PMCID: PMC8945867 DOI: 10.1038/s41433-022-02027-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the proportion of maculopathy detectable only on optical coherence tomography (OCT) versus slit lamp indirect ophthalmoscopy (SLIO) during cataract assessment. METHODS Population: Consecutive patients attending cataract assessments. DATA COLLECTION All patients underwent OCT and SLIO. SLIO findings were recorded before reviewing OCT. Scans were examined to compare with recorded SLIO findings. PRIMARY OUTCOME analyse the proportion of eyes with maculopathy missed by SLIO. SECONDARY OUTCOME to assess the proportion of patients with maculopathy on OCT, the incidence of maculopathy in the fellow eye on OCT and proportion with cataracts too dense to allow SLIO or OCT. RESULTS Six hundred twenty-six patients were enroled. Eighty (12.8%) had maculopathy detectable only on OCT which included: 26 (4.2%) epiretinal membrane (ERM), 25 (4%) dry age-related macular degeneration (AMD), 19 (3%) vitreomacular traction (VMT), 5 (0.8%) lamellar macular hole (LMH), 2 (0.3%) cystoid macular oedema (CMO) and 1 (0.2%) wet AMD. 166 (26.5%) had maculopathy on OCT, of which only 48 (7.7%) had known history of maculopathy. In fellow eyes, 29 (4.6%) had significant findings and 29 (4.6%) were unable to have SLIO or OCT due to dense cataract. CONCLUSIONS A quarter of the patients had occult maculopathy. One-tenth of the occult maculopathy were missed without OCT, with ERM, dry AMD, VMT, LMH, CMO and wet AMD being the primary missed diagnosis. Less than 5% had occult maculopathy in fellow eye, and <5% had dense cataracts where neither SLIO nor OCT was not possible.
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Affiliation(s)
- George Murphy
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Raisah Owasil
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Sam Kanavati
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Zahra Ashena
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Mayank A Nanavaty
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK.
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK.
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Elhusseiny AM, Salim S. Cataract surgery in myopic eyes. Curr Opin Ophthalmol 2023; 34:64-70. [PMID: 36473016 DOI: 10.1097/icu.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We discuss the preoperative, intraoperative, and postoperative considerations for cataract surgery in eyes with high myopia. We also reviewed the recent literature on refractive outcomes and complications of cataract surgery in myopic eyes. RECENT FINDINGS Several novel intraocular lens (IOL) power calculation formulas have recently been developed to optimize refractive outcomes. Haigis formula is the most accurate among the third-generation IOL formulas. Novel formulas such as Barrett Universal II, Kane, and modified Wang-Koch adjustment for Holladay I formula provide a better refractive prediction compared with old formulas. Intraoperatively, the chopping technique is preferred to minimize pressure on weak zonules and reduce the incidence of posterior capsule rupture. Anterior capsular polishing is recommended to reduce the risk of postoperative capsular contraction syndrome (CCS). Postoperatively, complications such as refractive surprises, intraocular pressure spikes, and CCS remain higher in myopic eyes. Only 63% of myopic patients with axial length more than 26 mm achieve a visual acuity at least 20/40 after cataract surgery, mainly because of coexisting ocular comorbidities. SUMMARY There are multiple preoperative, intraoperative, and postoperative considerations when performing cataract surgery in myopic eyes. Further research is needed to optimize the refractive outcomes in these eyes and determine the best IOL formula. Surgeons should be adept and knowledgeable with different techniques to manage intraoperative complications.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School
| | - Sarwat Salim
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
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Herranz-Cabarcos A, Vega-López Z, Salas-Fandos O, Quiroz-Quiroga MJ, Burgos-Fernández P, Martí-Rodrigo P, Castilla-Marti M, Poposki V, Martínez-Palmer AR. Macular optical coherence tomography for screening of pathology prior to cataract surgery: An approach based on tele-evaluation. Eur J Ophthalmol 2022; 32:3433-3437. [PMID: 35187961 DOI: 10.1177/11206721221080818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To assess the benefit of macular spectral-domain optical coherence tomography (SD-OCT) as a part of the routinary preoperative study of patients undergoing cataract surgery. METHODS A prospective single-center study study was performed. Consecutive patients with normal biomicroscopic funduscopy, moderate cataract and no history of ophthalmological pathologies were enrolled. All patients underwent macular SD-OCT. The obtained images were analysed by a general ophthalmologist and two retina specialists. Incidence of macular pathology and its relation to age and comorbidities were assessed. RESULTS Eight-hundred and thirty-six eyes of 419 patients were enrolled in this study. All images were analysed telematically by a general ophthalmologist. Forty-nine eyes were excluded due to insufficient quality of the obtained images. Abnormal images were observed in 156 eyes (18.6%), including age-related macular degeneration in 68 (8.2%), epiretinal membrane (ERM) in 67 (8.0%), cystoid macular edema in 3 eyes (0.4%), among others. Diagnostics with severe impact on patient visual prognosis were observed in 16 eyes (3.82%) from 12 patients. The relationship between incidence of macular pathologies and age or comorbidities was not statistically significant. To assess accuracy of the first observer, images were subsequently analysed by two retinologists. The kappa index of concordance was 0.80 and 0.85. CONCLUSIONS Implementing a systematic macular SD-OCT as a preoperative test prior to cataract surgery would improve quality of postoperative visual prognosis information. A general ophthalmologist would be suitable to screen for pathology through macular OCT images.
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Affiliation(s)
| | - Z Vega-López
- 16546Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain
| | - O Salas-Fandos
- 16546Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain
| | | | | | - P Martí-Rodrigo
- 16546Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain
| | - M Castilla-Marti
- 16546Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain
| | - V Poposki
- 16546Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain
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Alizadeh Y, Akbari M, Moghadam RS, Medghalchi A, Dourandeesh M, Bromandpoor F. Macular Optical Coherence Tomography before Cataract Surgery. J Curr Ophthalmol 2021; 33:317-322. [PMID: 34765821 PMCID: PMC8579804 DOI: 10.4103/joco.joco_240_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: To determine the benefits of performing preoperative spectral domain optical coherence tomography (SD-OCT) and to identify occult macular pathologies in patients scheduled for routine cataract surgery. Methods: In this cross-sectional study, macular SD-OCT scans were performed on all patients with clinically undetected macular abnormalities who were scheduled for cataract surgery. Patients with clinically evident macular abnormalities were excluded from the study. A retinal specialist reviewed all the scans. The severity of the cataract was determined using the Oxford Clinical Cataract Classification and Grading System. Results: Of the 598 evaluated cases, 33 patients (5.52%) had an occult macular abnormality. The most common pathology found in these patients was idiopathic epiretinal membrane, which was detected in 17 eyes (51.52%), followed by vitreomacular traction in nine eyes (27.27%), and dry age-related macular degeneration in four eyes (12.12%). Full-thickness macular holes and a lamellar macular hole were found in two patients (6.06%) and one patient (3.03%), respectively. The frequency of cortical cataracts was significantly lower in patients without macular lesions (P = 0.012) than in those with macular lesions. Multivariate logistic regression analysis revealed that age >70 years (P = 0.025 and odds ratio [OR] =11.12), smoking history (P = 0.043 and OR = 3.43), and hypertension were independently associated with occult macular lesions. The surgical plan was changed for five patients (0.83%). Conclusions: Macular SD-OCT can be used to detect occult macular lesions and provide useful information about a macula before cataract surgery. Although preoperative OCT found macular abnormalities in about 5% of patients with presumed normal fundus examination, it can result in changing the surgical plan in 0.83% of all patients.
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Affiliation(s)
- Yousef Alizadeh
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Mitra Akbari
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Reza Soltani Moghadam
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Abdolreza Medghalchi
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Maryam Dourandeesh
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Fariborz Bromandpoor
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
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Wei L, He W, Wang J, Zhang K, Du Y, Qi J, Meng J, Qiu X, Cai L, Fan Q, Zhao Z, Tang Y, Ni S, Guo H, Song Y, He X, Ding D, Lu Y, Zhu X. An Optical Coherence Tomography-Based Deep Learning Algorithm for Visual Acuity Prediction of Highly Myopic Eyes After Cataract Surgery. Front Cell Dev Biol 2021; 9:652848. [PMID: 34124042 PMCID: PMC8187805 DOI: 10.3389/fcell.2021.652848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background Due to complicated and variable fundus status of highly myopic eyes, their visual benefit from cataract surgery remains hard to be determined preoperatively. We therefore aimed to develop an optical coherence tomography (OCT)-based deep learning algorithms to predict the postoperative visual acuity of highly myopic eyes after cataract surgery. Materials and Methods The internal dataset consisted of 1,415 highly myopic eyes having cataract surgeries in our hospital. Another external dataset consisted of 161 highly myopic eyes from Heping Eye Hospital. Preoperative macular OCT images were set as the only feature. The best corrected visual acuity (BCVA) at 4 weeks after surgery was set as the ground truth. Five different deep learning algorithms, namely ResNet-18, ResNet-34, ResNet-50, ResNet-101, and Inception-v3, were used to develop the model aiming at predicting the postoperative BCVA, and an ensemble learning was further developed. The model was further evaluated in the internal and external test datasets. Results The ensemble learning showed the lowest mean absolute error (MAE) of 0.1566 logMAR and the lowest root mean square error (RMSE) of 0.2433 logMAR in the validation dataset. Promising outcomes in the internal and external test datasets were revealed with MAEs of 0.1524 and 0.1602 logMAR and RMSEs of 0.2612 and 0.2020 logMAR, respectively. Considerable sensitivity and precision were achieved in the BCVA < 0.30 logMAR group, with 90.32 and 75.34% in the internal test dataset and 81.75 and 89.60% in the external test dataset, respectively. The percentages of the prediction errors within ± 0.30 logMAR were 89.01% in the internal and 88.82% in the external test dataset. Conclusion Promising prediction outcomes of postoperative BCVA were achieved by the novel OCT-trained deep learning model, which will be helpful for the surgical planning of highly myopic cataract patients.
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Affiliation(s)
- Ling Wei
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | | | - Keke Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yu Du
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiao Qi
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiaqi Meng
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiaodi Qiu
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Lei Cai
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Qi Fan
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhennan Zhao
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yating Tang
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Shuang Ni
- Department of Ophthalmology, Heping Eye Hospital, Shanghai, China
| | - Haike Guo
- Department of Ophthalmology, Heping Eye Hospital, Shanghai, China
| | - Yunxiao Song
- Illinois Computer Science, University of Illinois, Champaign, IL, United States
| | - Xixi He
- Visionary Intelligence Ltd, Beijing, China
| | | | - Yi Lu
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and ENT Hospital, Eye Institute, Fudan University, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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10
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Hong SY, Kim S, Chung SH. Prevalence of Macular Abnormalities Identified Only on Optical Coherence Tomography in Korean Patients Scheduled for Cataract Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:153-158. [PMID: 33596625 PMCID: PMC8046618 DOI: 10.3341/kjo.2020.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the prevalence of macular abnormalities identified only on macular optical coherence tomography (OCT) which were not suspected by biomicroscopic fundus examination, and examine the clinical outcome of patients with these macular abnormalities during preoperative evaluation for cataract surgery in a large series of Korean patients.<br/>. METHODS Macular OCT was performed on patients scheduled for routine cataract surgery by the same physician at Seoul St. Mary's Hospital, between June 2018 and November 2019. The patients' medical records were reviewed retrospectively to obtain demographic data and the results of preoperative evaluation before cataract surgery. Patients were divided into two groups based on the preoperative macular OCT. RESULTS normal and abnormal OCT groups. RESULTS Nine hundred eighty-seven eyes (698 patients) were included in this study. Macular OCT identified abnormalities in 44 eyes (4.5%) of 35 patients (5.0%). Twenty-one eyes (2.1%) had age-related macular degeneration, 20 eyes (2.0%) had epiretinal membrane, and three eyes (0.3%) had lamellar hole. Patients with macular abnormalities identified on macular OCT had a statistically significant higher mean age than those who had normal OCT findings (p < 0.001). Best-corrected visual acuity was worse in patients with abnormal macular OCT after cataract surgery (p = 0.048). CONCLUSIONS In the preoperative evaluation for cataract surgery in Korean patients, one in every 20 patients had macular abnormalities identified only on macular OCT in spite of unremarkable macular findings on biomicroscopic funduscopy. Age was significantly higher in patients with abnormal macular OCT findings. Thus, inclusion of macular OCT examination in preoperative screening before routine cataract surgery would be beneficial.
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Affiliation(s)
- Seo-Yeon Hong
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seonjoo Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Hyang Chung
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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11
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Leung EH, Gibbons A, Koch DD. Cost-Effectiveness of Preoperative OCT in Cataract Evaluation for Multifocal Intraocular Lens. Ophthalmology 2020; 127:859-865. [PMID: 32173111 PMCID: PMC7311225 DOI: 10.1016/j.ophtha.2020.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the cost effectiveness of an adjunctive screening OCT during the preoperative evaluation of a patient considering cataract surgery with a multifocal intraocular lens (IOL) implantation. DESIGN Cost-effectiveness analysis. PARTICIPANTS A 67-year-old man with 20/60 vision undergoing evaluation for first-eye cataract surgery. METHODS The cost-effectiveness analysis of the reference patient undergoing a preoperative cataract examination with and without a screening OCT was performed, evaluating for vitreoretinal diseases including an epiretinal membrane, age-related macular degeneration, vitreomacular traction, and cystoid macular edema. It was assumed that patients with macular pathologies detected before surgery would receive a monofocal IOL and be referred to a retina specialist for evaluation and management. The Medicare reimbursable cost of an OCT was $41.81. All costs and benefits were adjusted for inflation to 2019 United States dollars and discounted 3% per annum over a 16-year time horizon. Probability sensitivity analyses and 1-way deterministic sensitivity analyses were performed to assess for uncertainty. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratio and incremental cost-utility ratio (ICUR) measured in quality-adjusted life years (QALYs). RESULTS Approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be detected on the initial clinical examination. In the base case, an adjunctive preoperative OCT was cost effective from a third-party payer and societal perspective in the United States. In the probability sensitivity analyses, the ICURs were within the societal willingness-to-pay threshold of $50 000/QALY in approximately 64.4% of the clinical scenarios. CONCLUSIONS A preoperative screening OCT during the evaluation of a patient considering a multifocal IOL added to the costs of the cataract surgery, but the OCT increased the detection of macular pathologies and improved the QALYs over time. An adjunctive screening OCT can be cost effective from a third-party payer and societal perspective.
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Affiliation(s)
- Ella H Leung
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
| | - Allister Gibbons
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Douglas D Koch
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Optical Coherence Tomography: Critical Tool to Manage Expectations after Cataract Extraction. CURRENT OPHTHALMOLOGY REPORTS 2020; 8:129-135. [PMID: 33094032 DOI: 10.1007/s40135-020-00243-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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. 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 postoperative 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 postoperative visual surprises.
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Swept-Source Optical Coherence Tomography Biometer as Screening Strategy for Macular Disease in Patients Scheduled for Cataract Surgery. Sci Rep 2019; 9:9912. [PMID: 31289313 PMCID: PMC6616355 DOI: 10.1038/s41598-019-46243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/24/2019] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to assess the central macular imaging captured with an optical biometer based on full-eye-length Swept-Source OCT (SS-OCT) scan as a screening strategy for identifying macular diseases in patients scheduled for cataract surgery. 1,114 eyes of 749 consecutive patients underwent a biometrical examination with IOLMaster 700 SS-OCT technology (Carl Zeiss) and conventional Spectral-Domain OCT (SD-OCT) (Spectralis OCT, Heidelberg) device analysis on the same day. Seven examiners graded the scans individually in a full-masked mode. Twenty-five eyes were excluded for media opacities. Among the 1,089 included eyes, statistical analysis revealed a mean Kendall's Coefficient of 0.83 (range 0.76-0.89). A logistic regression model demonstrated a highly significant correlation (p < 0.001) between the coefficient of concordance and SD-OCT imaging. Intraobserver reproducibility was 0.89 (range 0.86-0.91). Optical biometer SS-OCT scans showed a mean sensitivity of 0.81 and a mean specificity of 0.84. The positive and negative predictive value detected was 0.78 and 0.86, respectively. In order to predict the risk of reduced visual recovery, especially in cases of retinal pathology, optical biometer with SS-OCT scan has proven to be a useful modality for detecting macular structural abnormalities in patients undergoing cataract surgery. Conventional SD-OCT remains mandatory to confirm the presumed diagnosis.
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Pinto WP, Rabello LP, Ventura MC, Rocha CS, Ventura BV. Prevalence of macular abnormalities identified only by optical coherence tomography in Brazilian patients with cataract. J Cataract Refract Surg 2019; 45:915-918. [DOI: 10.1016/j.jcrs.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 12/16/2022]
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Sudhalkar A, Vasavada V, Bhojwani D, Raju CG, Vasudev P, Jain S, Praveen MR. Incorporating Optical Coherence Tomography in the Cataract Preoperative Armamentarium: Additional Need or Additional Burden? Am J Ophthalmol 2019; 198:209-214. [PMID: 30389372 DOI: 10.1016/j.ajo.2018.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the usefulness of preoperative optical coherence tomography (OCT) examination to detect asymptomatic macular abnormalities in patients scheduled for cataract surgery. METHODS Design: Prospective, interventional case series. SETTING Iladevi Cataract and Visakha Eye Center, Ahmedabad, India. STUDY POPULATION Patients undergoing cataract surgery and intraocular lens (IOL) implantation for senile cataracts. Preoperatively no retinal/macular pathology was identified on clinical evaluation. INTERVENTION All eyes underwent macular 5-line raster evaluation using spectral-domain OCT before and after cataract surgery (monthly for 3 months). Central subfield thickness (CST) analysis was done. OUTCOME MEASURES The primary outcome measure was determining the incidence of asymptomatic retinal lesions on OCT examination in clinically "normal" maculas. Secondary outcome measures included documenting change in corrected distance visual acuity and OCT thickness postoperatively. RESULTS A total of 1444 eyes were evaluated. OCT revealed asymptomatic lesions in 133 (9.21%) patients. At 3 months, all eyes showed significant median visual improvement (from 0.45 ± 0.13 logMAR to 0.06 ± 0.08 logMAR; P = .015) and insignificant median CST change (from 223.34 ± 21.1 μm to 249.12 ± 19.24 μm; P = .19). One eye showed increased vitreomacular traction (3 months). Patients with asymptomatic lesions did not have significantly worse postoperative visual outcomes at 3 months (from 0.52 ± 0.16 logMAR to 0.14 ± 0.1 logMAR; P = .12). CONCLUSION A total of 9.21% patients with clinically normal maculas had subtle pathology detected on OCT, but this subset of patients did not have worse postoperative visual outcomes compared to eyes with normal OCT scans. Thus, a careful pre-cataract surgery fundus examination remains an essential part of the presurgical patient evaluation.
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Abstract
PURPOSE OF REVIEW To provide a consolidated update regarding preoperative evaluation for cataract surgery. RECENT FINDINGS Visual acuity alone is a poor gauge of cataract disability. Modalities such as wave front aberrometry, lens densitometry, and light-scatter assessments can quantify optical aspects of cataract and may prove clinically useful in surgical evaluation. Advances in biometry are driving improvements in refractive outcomes, which in turn have increased patient expectations. Future advances in biometry technology may include three-dimensional imaging of the cornea and lens. Screening for ocular comorbidities has become increasingly important, particularly to guide lens selection. Risk stratification systems can help guide surgical decisions and may decrease intraoperative complication rate. A comprehensive medical history and physical is currently mandated for all Medicare patients undergoing cataract surgery but may be of limited utility for low-risk patients. SUMMARY Rising patient expectations and a growing number of surgical choices have expanded the cataract preoperative evaluation. A systematic and comprehensive examination which includes identifying any ocular comorbidity is essential for surgical planning and counseling on visual prognosis. New technologies will continue to inform, but not replace, sound clinical judgment.
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