Patient Management Modifications In Cataract Surgery Candidates Following Incorporation Of Routine Preoperative Retinal Nerve Fiber Layer Optical Coherence Tomography

To assess the clinical relevance of routine preoperative spectral domain optical coherence tomography of the retinal nerve fiber layer (OCT RNFL) for identifying Glaucoma pathology in patients scheduled for cataract surgery

Shaare Zedek Medical Center, Jerusalem, Israel

Retrospective case series of Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from February 2022 to August 2022. All study patients underwent routine OCT RNFL scanning before cataract surgery. The scans were reviewed by a glaucoma specialist for detection  of glaucoma pathology and compared with preoperative fundus biomicroscopic examination findings. The incidence of glaucomatotus optic nerve pathology and changes in patient management as a result of the OCT RNFL findings were assessed.

Five hundred and three eyes of 503 patients met the inclusion criteria and were enrolled in the study. Significant RNFL pathologies were detected by OCT RNFL in 129 eyes (25.6%) of which 98 (20.7%) were attributed to glaucoma and 31 (6.6%) to other pathologies affecting the peripappillary nerve fiber layer. Overall, the management of 56 patients (11.9%) was modified due to OCT RNFL findings. Changes in patient management included enrolling patients to routine glaucoma follow up due to ocular hypertension or glaucoma suspicion (28 eyes[5.5 %]) adding glaucoma treatment (either IOP lowering drops or SLT treatment, 17 eyes[3.4%])and converting surgery to a combined procedure of cataract and glaucoma surgery (10 eyes [1.7%])

Routine OCT RNFL scans for cataract surgery candidates helped to identify glaucoma pathology that might be missed by standard fundus biomicroscopic examination. The added information could improve patient management