EyeWorld India March 2012 Issue

42 EW RETINA March 2012 Dr. Fung performs an injection on a patient Source: Anne Fung, MD Dr. Fung drawing Lucentis (Genentech, South San Francisco, Calif., USA) Source: Anne Fung, MD Consider the macula in pre-op cataract patients by Jena Passut EyeWorld Staff Writer Retina specialists offer advice on what to look for in order to attain best vision S urgical complications arise, even in cataract surgery, which reportedly has one of the highest success rates. Yet despite all the various pre-op tests that are performed to ensure a successful operation—from measuring the eye and cornea to deciding on the best IOL fit—there are always potential problems that may be overlooked during the procedure, especially from the back of the eye. The most common missed maculopathies that result in unhappy cataract patients are vitreoretinal interface abnormalities, such as epiretinal membranes and vitreoretinal traction, according to Michael D. Ober , MD , Retina Consultants of Michigan, Southfield, Mich., USA. “Those are probably the most common disorders, but age-related macular degeneration closely follows,” Dr. Ober said. What is a clinician to do pre-op to ensure these retina issues won’t pop up or cause vision problems after surgery? Three specialists spoke to EyeWorld about imaging the back of the eye and testing for visual acuity before going into the operating room. Imaging the back of the eye Dr. Ober said if there is suspicion from pre-op testing that a maculopathy may be present, “an OCT [optical coherence tomography] is probably the best screening tool. It will give you a lot of information. It’s not going to help you with a patient who has dry macular degeneration that is not high risk or affecting the central vision, but it will give you a much better idea of the vitreoretinal surface, and it will also tell you whether there is subretinal fluid or macular edema that’s pre-existing.” Suspicious factors include a family history of the disease or if the patient’s pre-op vision is not what the doctor would expect based on the level of cataract present. The OCT can help clinicians determine beforehand if there’s a macular pathology that could lower the patient’s visual potential, whereas biomicroscopy or other tests might not pick up on those subtle changes. “OCT evaluation is important to look at the structure of the retina, particularly the macula,” said Elias Reichel , MD, professor and vice chair of ophthalmology, Tufts University, Boston, Mass., USA. “It is important as a preoperative assessment because even if our view is good, often we can miss subtle maculopathy. Occasionally, we find choroidal neovascularization from wet age-related macular degeneration that hasn’t been seen before. In diabetic patients, we see diabetic maculopathy that’s difficult to view through a visually significant cataract.” Dr. Reichel said assessing the macula in cataract surgery patients is “critical for a patient’s high expectations”. AT A GLANCE • A good cataract surgeon should consider the back of the eye and possible hidden maculopathies there before heading to the OR with a patient • A potential acuity meter measures how a person might see after cataract surgery • The PAM is useful in determining if visual problems stem from the cataract or macula, according to some, but is not terribly reliable Dr. Fung consults with a patient Source: Anne Fung, MD continued on page 44