Why I Perform OCT On 100% of My Cataract Patients

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4 min read

Sit down with Preeya K. Gupta, MD, and Elizabeth Yeu, MD, to review why macular optical coherence tomography (OCT) is critical for cataract evaluations.

Welcome back to Interventional Mindset. In this episode, Preeya K. Gupta, MD, sits down with Elizabeth Yeu, MD, to discuss why they perform macular optical coherence tomography (OCT) imaging on all cataract patients.
Dr. Yeu is a fellowship-trained cornea, anterior segment, and refractive surgeon who is a partner at Virginia Eye Consultants. In addition, she is an assistant professor of ophthalmology at the Eastern Virginia Medical School in Norfolk, Virginia, and was the 2023/2024 President of the American Society of Cataract and Refractive Surgery (ASCRS).

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Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.

Including OCT in routine pre-operative evaluations for cataract patients

Dr. Yeu noted that she considers macular OCT imaging to be a part of routine testing in pre-operative evaluations for all cataract patients, and not just reserved for premium intraocular lens (IOL) patients. She added that, in her opinion, similar to corneal topography, macular OCT has increasingly become a standard of care for anterior segment surgeons in pre-operative cataract evaluations.
In order to holistically understand the patient’s ocular health prior to cataract surgery, she includes diagnostic testing such as infrared meibography, macular OCT, and several corneal topographies into workups. She then takes this information into account when selecting IOLs and considers what other interventions the patient may require outside of cataract surgery to maintain or improve their ocular health.

Identifying AMD in cataract patients with OCT imaging

Using OCT imaging, surgeons can assess the foveal architecture and identify the presence of retinal disease, even when the foveal center and surrounding area appear normal on direct examination.1 For example, a 2022 study of 453 patients undergoing cataract surgery suggested that 41% of eyes demonstrated macular pathology, and 50% of these patients had age-related macular degeneration (AMD).2
Overall, the management of 107 patients (26.0%) was changed due to macular OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundoscopic examination.2 Drs. Gupta and Yeu emphasized how understanding the pathophysiology of common retinal diseases, such as AMD, allows surgeons to accurately address the patient’s visual symptoms and proactively educate them on available treatments.

Pearl: Dr. Gupta recommended reviewing OCT scans to rule out common pathologies, such as AMD, epiretinal membrane (ERM), and macular edema.

Referring cataract patients with AMD

As drusen and retinal pigment epithelium (RPE) changes are two hallmark findings associated with dry AMD,3 when Dr. Yeu sees cataract patients with both on macular OCT, she makes sure to ask whether they have received a previous diagnosis of AMD or GA. Depending on the response, she then considers referring the patient to a retina specialist for more targeted care.
When it comes to referring these patients to retina specialists, Dr. Gupta noted that although she will not manage the patient’s retinal disease, making the diagnosis is key to educating the patient, determining the next step in treatment, and choosing an optimal IOL.

Conclusion

With the recent development and approval of complement inhibition treatments for GA, Dr. Gupta explained that she feels compelled to refer AMD patients because there are now therapies available to intervene early in the disease process and slow the rate of vision loss.3
With an estimated 3.7 million cataract cases per year in the US,4 Dr. Yeu emphasized that anterior segment surgeons are very likely to encounter patients with concurrent AMD, and adding macular OCT to routine pre-operative cataract evaluations improves not only surgical outcomes but also GA screening.

Watch the full interview to learn more about which factors Drs. Gupta and Yeu consider when referring patients to retina specialists for GA!

  1. Miller KM, Oetting TA, Tweeten JP, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2022;129(1):PP1-P126. doi: 10.1016/j.ophtha.2021.10.006
  2. Weill Y, Hanhart J, Zadok D, et al. Patient Management Modifications in Cataract Surgery Candidates Following Incorporation of Routine Preoperative Macular Optical Coherence Tomography. J Cataract Refract Surg. 2021;47(1):78-82. doi: 10.1097/j.jcrs.0000000000000389
  3. Nielson MK, Shah YS, Tripathy K, et al. Geographic Atrophy. EyeWiki. September 22, 2024. Accessed September 25, 2024. https://eyewiki.org/Geographic_Atrophy.
  4. Rossi T, Romano MR, Iannetta D, et al. Cataract Surgery Practice Patterns Worldwide: A Survey. BMJ Open Ophthalmol. 2021;6(1):e000464. doi: 10.1136/ bmjophth-2020-000464
Preeya K. Gupta, MD
About Preeya K. Gupta, MD

Dr. Gupta earned her medical degree at Northwestern University’s Feinberg School of Medicine in Chicago, and graduated with Alpha Omega Alpha honors. She fulfilled her residency in ophthalmology at Duke University Eye Center in Durham, North Carolina, where she earned the K. Alexander Dastgheib Surgical Excellence Award, and then completed a fellowship in Cornea and Refractive Surgery at Minnesota Eye Consultants in Minneapolis. She served on the faculty at Duke University Eye Center in Durham, North Carolina as a Tenured Associate Professor of Ophthalmology from 2011-2021.

Dr. Gupta has authored many articles in the peer-reviewed literature and serves as an invited reviewer to journals such as Ophthalmology, American Journal of Ophthalmology, and Journal of Refractive Surgery. She has also written several book chapters about corneal disease and ophthalmic surgery, as well as served as an editor of the well-known series, Curbside Consultation in Cataract Surgery. She also holds several editorial board positions.

Dr. Gupta serves as an elected member of the American Society of Cataract and Refractive Surgery (ASCRS) Refractive Surgery clinical committee, and is also is the Past-President of the Vanguard Ophthalmology Society. She gives presentations both nationally and internationally, and has been awarded the National Millennial Eye Outstanding Female in Ophthalmology Award, American Academy of Ophthalmology (AAO) Achievement Award, and selected to the Ophthalmologist Power List.

Preeya K. Gupta, MD
Elizabeth Yeu, MD
About Elizabeth Yeu, MD

Elizabeth Yeu, MD, earned her medical degree through an accelerated and combined undergraduate/medical school program at the University of Florida College of Medicine. She completed her ophthalmology residency at Rush University Medical Center in Chicago, Illinois, where she served as Chief Resident (2006–2007).

Dr. Yeu continued to the Cullen Eye Institute, Baylor College of Medicine to complete a fellowship in Cornea, Anterior Segment, and Refractive Surgery (2007–2008), where she served as an Assistant Professor after her fellowship training.

Dr. Yeu joined Virginia Eye Consultants in Norfolk, Virginia, in 2013, and became a partner in 2014. She continues her commitment to residency training in ophthalmology as an assistant professor at the Eastern Virginia Medical School. She is the Medical Director of the Virginia Surgery Center and sits on the Board of Directors for the Virginia Eye Foundation.

Dr. Yeu provides guidance and governance across several national medical boards and committees, including as an examiner for the American Board of Ophthalmology, current Advisor (past Chair (2013–17)) of the ASCRS Young Eye Surgeons (YES) Clinical Committee, and as the Chair of the Cataract Section of Ophthalmic News & Education (ONE) Network for the American Academy of Ophthalmology.

Dr. Yeu has authored numerous articles and is a frequent lecturer nationally and internationally in the areas of refractive cataract surgery, anterior segment reconstruction, ocular surface disease management, and surgical management of astigmatism. She is the Editor-In-Chief of U.S. Ophthalmic Review and served as the Medical Editor of the digital journal, Millennial Eye from 2015–2017. Dr. Yeu has been recognized with many awards and on power lists.

Elizabeth Yeu, MD
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