Impact of lens opacity and axial length on concomitant screening of maculopathy by swept-source optical coherence tomography-based optical biometer

BACKGROUND: Preoperative evaluation of macular disorders is crucial to predict postoperative visual outcomes among patients with cataract. The swept-source optical coherence tomography (SS-OCT) based optical biometer was proved to be useful in screening macular pathology, while the impact of lens opacities and axial lengths on macular disease screening using SS-OCT based optical biometer remained unknown. This study aimed to evaluate the influence of lens opacities and axial lengths on foveal image quality detected by SS-OCT-based optical biometer, as well as sensitivity and specificity for the detection of macular diseases. METHODS: This was a diagnostic accuracy study that retrospectively included patients who underwent preoperative cataract examinations at our hospital between November 2020 and June 2021. All patients underwent SS-OCT based optical biometer and spectral-domain OCT (SD-OCT). The SD-OCT was the golden standard for diagnosing macular diseases. Sensitivity, specificity, and receiver operating characteristic (ROC) were calculated to evaluate the value of foveal SS-OCT scans for the detection of macular disease. RESULTS: Of the 224 eyes enrolled in the study, 82 eyes were diagnosed with macular disease by SD-OCT. The foveal image was almost indistinguishable due to poor quality when the mean grayscale of the image was less than 40. The posterior subcapsular opacity score and the axial length were significantly correlated with the gray density of the foveal image (r=−0.70, P<0.0001 and r=−0.40, P<0.0001). After excluding cases with indistinguishable foveal images (subcapsular opacities score ≥3.5, axial length ≥28.9 mm), the SS-OCT yielded 68% (95% confidence interval, 0.54–0.79) sensitivity and 87% (95% confidence interval, 0.78–0.92) specificity in 136 eyes. CONCLUSIONS: Routine SS-OCT based biometric measurement for the evaluation of macular pathology simultaneously prior to cataract surgery is suggested except for patients with advanced cataract (posterior subcapsular opacities score ≥3.5) and long axial length (≥28.9 mm).