For patients considering cataract surgery with a multifocal intraocular lens (IOL), optical coherence tomography (OCT) done prior to the procedure may increase the overall cost, but it also could be beneficial in detecting other macular pathologies and improving quality of life, a study in Ophthalmology reports.

Based on their analysis, researchers found approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be found during the initial clinical exam.

The investigation’s base case was a 67-year-old male with 20/60 vision who underwent evaluation for his first cataract surgery. The preoperative cataract exam was done with and without a screening OCT evaluation for retinal diseases including epiretinal membrane, age-related macular degeneration, vitreomacular traction and cystoid macular edema. It was assumed that patients with macular pathologies detected preoperatively would receive a monofocal IOL and be referred to a retina specialist for evaluation and management, researchers said.

The Medicare reimbursable cost of an OCT was $41.81, and all costs and benefits were adjusted for inflation to 2019 U.S. dollars discounted at 3% per annum over a 16-year time-horizon.

 “In the base case, an adjunctive preoperative OCT was cost-effective from a third-party payer and societal perspective in the U.S.,” researchers wrote.

Based on a willingness-to-pay threshold of a $50,000/quality of life year, the study estimated 64.4% of patients would agree to the additional cost for an OCT prior to cataract surgery.

Leung EH, Gibbons A, Koch D, et al. Cost-effectiveness of preoperative optical coherence tomography in cataract evaluation for multifocal intraocular lens. Ophthalmology. January 31, 2020, [Epub ahead of print].