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

To study the prevalence of occult macular pathology using optical coherence tomography (OCT) during the preoperative evaluation for cataract surgery and associated risk factors.

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.

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).

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.