EyeWorld India March 2019 Issue

55 March 2019 EWAP REFRACTIVE macular OCT abnormalities are highly motivated to reduce their need for contact lenses or glasses, and are willing to proceed with a presbyopia-correcting IOL despite the increased chance that they will not be able to experience a full range of vision. In my experience, some patients with a mild ERM can do quite well, especially with an extended depth of focus IOL, and when the macular condition is unilateral. However, the success rate is much lower, so the goal is to identify patients who are highly motivated and understand they may not achieve as much range in vision as a patient with a normal preoperative OCT. This is important, as patients typically are paying out of pocket and therefore may have high expectations. For this reason, the vast majority of patients who have an abnormal OCT are advised to choose a monofocal or toric IOL,” he said. Dr. Koch may proceed with surgery if the patient has an epiretinal membrane, but only if there’s minimal macular distortion and the foveal contour is good. “In this setting, I may proceed with a premium IOL that minimally compromises distance vision, such as an extended depth of focus lens like the Tecnis Symfony [Johnson & Johnson Vision, Santa Ana, California]. This IOL has such good optical quality that it does not degrade distance vision, so you implant it if the patient is eager to proceed down that pathway. I do advise patients of two things: They might not get the full benefit of the lens, and the epiretinal membrane could get worse and cause some visual difficulty. Candidly, I’ve never seen that happen,” he said. Reimbursement Macular OCT is only reimbursable in certain instances. “If we know beforehand that there is vitreoretinal pathology, we bill for it. But many times, we just eat that as a cost of the preoperative evaluation. The good news is that there’s no click fee associated with it. There’s no paper or ink that’s printed, so it’s just a quick examination from the standpoint of technician time,” Dr. Koch said. Dr. Hovanesian agreed. “We do an OCT for every single patient undergoing cataract surgery. If there is not a reason to bill for it, I don’t bill for it. It’s part of our refractive package price, and in some patients who aren’t having a premium surgery, I do it for free because it gives me the assurance of having a better idea of what’s going on in the macula than I would otherwise. I would encourage other doctors to begin thinking of the OCT as an extension of the retina exam for patients who are going to undergo surgery, where you need to know as much information about the macular health as you can,” he said. EWAP Editors’ note: Dr. Gupta has financial interests with Carl Zeiss Meditec. Dr. Hovanesian has financial interests with Alcon (Fort Worth, Texas), Bausch and Lomb (Bridgewater, New Jersey), Carl Zeiss Meditec, and Johnson & Johnson Vision. Dr. Koch has financial interests with Alcon and Johnson & Johnson Vision. Dr. Trattler has financial interests with Johnson & Johnson Vision. Contact information Gupta: preeya.gupta@duke.edu Hovanesian: drhovanesian@harvardeye.com Koch: dkoch@bcm.edu Trattler: wtrattler@gmail.com Preop OCT scans can reveal subtle pathology like epiretinal membranes that are difficult to identy with funduscopy through a dense cataract. Source: John Hovanesian, MD OCT image showing epiretinal membrane with advanced retinal changes that impact the surgical planning. Source: Douglas Koch, MD