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2019 ASCRS CLINICAL SURVEY | 9 HIGHLIGHTS OF THE 2019 ASCRS CLINICAL SURVEY Retina Respondents were asked why they do not perform OCT or fluorescein angiography (FA) on some pa- tients prior to cataract surgery, and 60% indicated that they don't think it's necessary. Respondents were also asked if they personally perform intravit- real injections for patients with macular degenera- tion before, during, or after cataract surgery. While 64.6% did not, 35% were performing these injections at some level. "While I agree that an FA may not be necessary for every pa- tient prior to cataract surgery, the value of a preoperative OCT cannot be overemphasized. In general, the patient population af- fected by cataracts is similar in age to that affected by common retinal pathologies, including macular degeneration. Overlooking a potentially vision-impacting retinal condition can lead to unan- ticipated poor postoperative results, and the patient may even blame your surgery for their unmet expectations. "Even if you perform a careful dilated funduscopic examination, findings such as epiretinal membranes and subtle cystoid macular edema can be missed, especially in the presence of a dense cataract. It takes just seconds to obtain an OCT with current technology, so if you have the capability, do it. And if you don't have access to an OCT machine or don't prefer to interpret images yourself, the patient can easily be referred to a retina colleague who will send the patient back to you. "For those who responded that retinal imaging is not necessary in this setting, consider that several studies have found significant proportions of patients to have occult retinal disease detected on OCT that was not identified on exam. Personally, I have seen cataract surgery patients in the immediate postoper- ative period with a variety of conditions—everything from wet macular degeneration to retinal detachment that was almost certainly present preoperatively. "[Regarding whether physicians perform intravitreal injections for patients with macular degeneration before, during, or after cataract surgery,] there are two issues embodied in this question—one concerning the treatment of wet macular degeneration in the context of cataract surgery and the other regarding who administers intravitreal injections for these patients. In terms of timing of injections in the perioperative period, it is ideal to schedule the surgery 1 or 2 weeks following an injection. However, if not possible, I personally do not alter a patient's injection schedule. The only caveat is that I try not to inject during the first few postoperative days when the wound may still be unstable. "When it comes to administering intravitreal injections, the complexity resides less in the injection itself and more in what comes before and after it. Confirming accurate diagnosis, select- ing and adjusting treatment regimens, interpreting nuanced OCT findings, and managing serious injection-related complications, should they occur, are paramount in the proper management of wet AMD. As retina specialists have received dedicated training to develop these skillsets, they are the best equipped to perform intravitreal injections. There are certainly situations where this may not be feasible; in these cases where a non-retina specialist is the one injecting, co-management and close communication with a retina specialist may be prudent." Christina Weng, MD ASCRS Retina Clinical Committee WHY DO YOU NOT PERFORM OPTICAL COHERENCE TOMOGRAPHY (OCT) OR FLUORESCEIN ANGIOGRAPHY (FA) ON SOME PATIENTS PRIOR TO CATARACT SURGERY? DO YOU PERSONALLY PERFORM INTRAVITREAL INJECTIONS FOR YOUR PATIENTS WITH MACULAR DEGENERATION, BEFORE, DURING, OR AFTER CATARACT SURGERY? Copyright © 2020 American Society of Cataract and Refractive Surgery (ASCRS). All rights reserved. No part of this survey may be reproduced without written permission from ASCRS, 12587 Fair Lakes Circle, Suite 348, Fairfax, VA 22033.

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