Incremental Predictive Value of Preoperative Macular Optical Coherence Tomography for Postoperative Visual Acuity...

Occult macular pathology may limit visual recovery after cataract surgery but can remain undetected on routine clinical examination due to media opacity. Preoperative macular optical coherence tomography (OCT) improves detection of such abnormalities; however, its incremental prognostic value beyond routinely available clinical predictors remains uncertain. This study evaluated whether preoperative macular OCT provides additional predictive information for early (30-120 day) postoperative visual acuity after phacoemulsification cataract surgery.

This retrospective cohort study included consecutive eyes undergoing phacoemulsification for nuclear cataract at a tertiary eye hospital in Saudi Arabia between April 2023 and April 2025. Eligible eyes had documented preoperative and postoperative best-corrected visual acuity (BCVA) and a preoperative macular OCT scan of adequate quality. The primary outcome was postoperative BCVA measured within 30-120 days after surgery. Multivariable analysis of covariance was used to identify predictors of postoperative BCVA. Incremental predictive value of OCT variables was assessed by comparing a base clinical model with an OCT-augmented model using changes in the coefficient of determination (R²), Akaike information criterion (AIC), and nested F-tests. Cluster-robust standard errors were applied to account for correlation between eyes from the same patient.

A total of 177 eyes were included, of which 57 (32%) demonstrated macular pathology on preoperative OCT. Eyes with macular pathology had worse preoperative BCVA but similar postoperative BCVA compared with eyes without pathology. In multivariable analysis, poorer preoperative BCVA (β = 0.224; P = 0.039) and older age (β = 0.090 per 10-year increase; P = 0.004) were independently associated with worse postoperative BCVA, whereas macular pathology was not. Adding OCT variables increased the model R² from 0.296 to 0.325 (ΔR² = 0.029; P = 0.029), indicating a statistically significant but modest improvement in predictive performance.

Preoperative BCVA and age were the primary predictors of early postoperative visual acuity after phacoemulsification cataract surgery. Although macular OCT detected abnormalities in nearly one-third of eyes and provided a statistically significant improvement in predictive performance, the magnitude of this gain was modest, suggesting limited additional value for short-term visual outcome prediction beyond standard clinical factors.