Utility of IOLMaster 700 Swept-Source Optical Coherence Tomography in Detecting Macular Disease for Preoperative Cataract Surgery Patients

Abstract

Purpose

To assess the efficacy of IOLMaster 700 (IOLM) biometer swept-source optical coherence tomography (SS-OCT) in detecting macular pathology before cataract surgery and to compare IOLM SS-OCT characteristics of foveal pathology with a widely used spectral-domain OCT (SD-OCT) system.

Patients and Methods

Retrospective analysis of 1156 consecutive eyes with IOLMaster 700 SS-OCT undergoing cataract surgery from January to June 2017 was performed. Approximately a third of these eyes (327 eyes) also had a SD-OCT scan performed previously. A single reviewer assessed each SS-OCT scan and identified them as “normal” or “abnormal.” SS-OCT sensitivity and specificity in identifying foveal pathology was assessed using findings on Spectralis SD-OCT scans as the gold standard.

Results

Of 327 eyes with both IOLM SS-OCT and Spectralis SD-OCT scans, 121 eyes (37.0%) had abnormal SS-OCT scans. Of these 121 eyes, SD-OCT scans confirmed pathology in 104 eyes (86.0%). Of the remaining 206 eyes graded to have normal SS-OCT scans, 84 eyes (40.8%) had normal SD-OCT scans, and 122 eyes (59.2%) had pathologic findings on SD-OCT scans. For each pathologic condition, subtle but definitive differences existed in the appearance of the IOLM SS-OCT and SD-OCT images.

Conclusion

Using a normal or abnormal Spectralis SD-OCT scan as confirmation of absence or presence of foveal pathology respectively, we found a high positive predictive value (86.0%) of an abnormal IOLM SS-OCT scan and a high specificity (83.2%) but low sensitivity (46.0%) and negative predictive value (40.8%) of a normal-appearing SS-OCT scan. These results suggest that an abnormal IOLM SS-OCT scan in an eye without known pathology is a strong indicator of an abnormal macula and should prompt further evaluation of the retina to identify pathology prior to cataract surgery. Importantly, IOLM SS-OCT scans do not detect all macular pathology and cannot be used as a screening test for identifying macular pathology.

Keywords:

• optical biometry
• macular OCT
• cataract surgery preoperative testing

Abbreviations

SS-OCT, swept-source optical coherence tomography; SD-OCT, spectral-domain optical coherence tomography; IR, inner retinal; OR, outer retinal; BM, Bruch’s membrane; RPE, retinal pigment epithelium; PR, photoreceptor; CH, choroid.

Acknowledgments

Supported in part by a grant from Research to Prevent Blindness (New York, NY) to the Department of Ophthalmology, Northwestern University Feinberg School of Medicine.

Disclosure

Dr Surendra Basti reports personal fees from JNJ vision, outside the submitted work. The authors report no other potential conflicts of interest for this work.