Applications of optical coherence tomography in cataract surgery

The rapid emergence and widespread adoption of optical coherence tomography (OCT) has spurred the development of many ophthalmic applications. Spectral domain OCT provides high-resolution in-vivo images of both anterior and posterior segments of the eye. Innovations in anterior segment OCT (AS-OCT) aim to improve refractive accuracy and reduce surgical risks. This review focuses on the utility of AS-OCT in cataract surgery for preoperative assessment, intraoperative assistance, and postoperative management to improve surgical outcomes.

Recent advances in AS-OCT for preoperative planning include characterization of dry eye and ocular surface conditions, calculation of intraocular lens (IOL) power, delineation of anterior chamber structures, and assessment of risk factors for postoperative complications. Successful intraoperative use of AS-OCT has been described for in-vivo assessment of clear cornea wound architecture and OCT-guided femtosecond laser-assisted cataract surgery. The essential roles of OCT in managing postoperative complications include characterization of maculopathy or corneal wound integrity, assessment of IOL stability or optical changes, and evaluation of laser-assisted in situ keratomileusis flaps after cataract surgery.

In its rapidly evolving state, the utility of OCT in cataract surgery continues to broaden with applications from preoperative planning, intraoperative image-based treatments, and postoperative care. We advocate the judicious use of OCT, wherever clinically indicated, because routine use may not be clinically necessary or economically feasible for each stage of cataract evaluation and management.