The Additive Value of Foveal OCT-based Biometry to Fundus Biomicroscopy for Detecting Macular Pathology Prior to Cataract Surgery.

PURPOSE To assess the additive value of foveal swept-source optical coherence tomography (SS-OCT) based biometry to the preoperative fundus examinations for diagnosing macular abnormalities in patients scheduled for cataract surgery. DESIGN Diagnostic testing evaluation. METHODS Consecutive patients 50 years of age and older planned for cataract surgery from one institution were retrospectively enrolled. All patients underwent foveal SS-OCT, and macular spectral-domain (SD)-OCT scans before pupil dilation as well as dilated fundus biomicroscopy examination. The effectiveness of fundus biomicroscopy examinations, foveal SS-OCT scans, and the combination of both in identifying macular diseases was analyzed with macular SD-OCT scans as reference. RESULTS Seventy-eight of the eligible 442 eyes (442 patients) were excluded due to non-interpretable macular SD-OCT scans or foveal SS-OCT scans. The remaining 364 eyes of 364 patients (mean age 73.59±9.26 years [range 49-96], 172 males) formed the study group. Fundus biomicroscopy alone vs fundus biomicroscopy with the addition of foveal SS-OCT yielded 36% vs 63% sensitivity, 94% vs 72% specificity, 79% vs 58% positive predictive value (PPV), and 71% vs 76% negative predictive value (NPV), respectively. This diagnostic improvement was significant compared to fundus biomicroscopy alone (p =2.98-8). CONCLUSION Combined fundus biomicroscopy and foveal SS-OCT scans improved the detection of macular abnormalities prior to cataract surgery but it was inferior to macular SD-OCT scans. Additional studies to assess the cost-effectiveness of adding foveal SS-OCT scan in comparison to macular SD-OCT scan to the pre-operative cataract evaluation are required.