Impact of optical coherence tomography on surgical decision making for epiretinal membranes and vitreomacular traction.
OBJECTIVE
To compare retina surgeons' recommendations for management of epiretinal membranes (ERM) and vitreomacular traction (VMT) based on clinical assessment alone with management based on clinical evaluation supplemented by optical coherence tomography (OCT).


METHODS
A prospective, masked clinical case series was conducted. Surgeons first performed a complete history and physical examination on patients referred with the macular disorders under study without the benefit of adjunctive OCT, determined whether ERM, VMT, and/or macular edema were present, questionably present, or absent, and made a provisional management recommendation. The retina specialists then reviewed the OCT images for the presence or absence of ERM, VMT, and/or associated macular edema and reconsidered the final management recommendation in light of clinical evaluation combined with OCT findings.


RESULTS
Eighty-four eyes of 73 patients were examined. ERM was identified in 66 (78.6%) of 84 eyes using clinical examination compared with 72 (85.7%) of 84 eyes using OCT (P = 0.06). VMT was identified in 5 (6%) of 84 eyes using clinical examination compared with 18 (21.4%) of 84 eyes using OCT (P < 0.005). Macular edema was identified in 57 (67.9%) of 84 eyes using clinical examination compared with 70 (83.3%) of 84 eyes using OCT (P = 0.003). Surgical intervention was recommended in 33 cases: 19 (57.6%) based on the history and clinical examination findings without OCT information and an additional 14 (42.4%) based on the combination of clinical evaluation and OCT findings.


CONCLUSIONS
OCT is more sensitive than clinical examination in detecting ERM, VMT, and associated macular edema. Taken together with careful clinical evaluation, OCT findings influenced surgeons to recommend consideration of surgery to an additional 14 patients (42.2%) in this series.
Do
Diana V
DV
Retina Division, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Cho
Minhee
M
Nguyen
Quan Dong
QD
Shah
Syed Mahmood
SM
Handa
James T
JT
Campochiaro
Peter A
PA
Zimmer-Galler
Ingrid
I
Sung
Jennifer U
JU
Haller
Julia A
JA
D003657:Decision Making; D019773:Epiretinal Membrane / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014822:Vitreous Body / Q000473:pathology*; D020255:Vitreous Detachment / Q000175:diagnosis* / Q000601:surgery