I was interested to read the article by Murphy et al. [1] in which the use of routine pre-operative retinal OCT was compared with clinical examination for a large group of patients being assessed for possible cataract surgery. The findings were interesting, but in my view the conclusions that were drawn are not supported by the findings, which could equally be used to support the opposite approach.
It is perhaps not surprising that 26.5% of a cohort of patients with an average age of 74.5 years had some form of maculopathy. The study goes on to state that of these patients, almost half had maculopathy detectable by OCT but not on clinical (slit-lamp) examination. This no doubt reflects greater sensitivity of OCT over slit-lamp examination, but may also indicate that much of the ‘occult maculopathy’ is not clinically significant disease.
How many of these patients had a change of clinical management as a result of the OCT findings? Only 3 out of 564 patients listed for surgery had a further consultation prior to surgery and they may well have gone on to have cataract surgery in any event. The time, money, and data storage involved in carrying out an OCT scan on all of the 400–500,000 patients attending for cataract surgery each year in the UK would be significant. The technicians required to carry out the scans are some of the hardest staff to recruit and are needed for diagnosis and monitoring of sight-threatening disorders such as glaucoma and wet AMD. Would the outcome of detecting a small proportion of mostly mild disease with little or no effect on clinical management be worth the financial and environmental cost?
The authors state that ‘OCT should be used in all cases for cataract pre-assessment’ In my view, they have not demonstrated that this approach is both an effective use of limited resources and clinically better than a careful assessment of whether the symptoms match the cataract, followed by further investigation (such as OCT), where appropriate.
Competing interests
The author declares no competing interests.
Footnotes
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Reference
- 1.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. 2023;37:665–9. doi: 10.1038/s41433-022-02027-0.. [DOI] [PMC free article] [PubMed] [Google Scholar]