Diagnostic errors when referring patients for cataract surgery

Abstract

To study the frequency of patients with macular pathology being wrongly diagnosed with cataract and possible reasons for this to occur. A total of 1390 patients (1390 eyes), in whom cataract turned out to be not the main cause of visual impairment, were recruited as research subjects. To reveal the reasons for misdiagnosis, we resorted to methods of ophthalmic examination that are available at ambulatory care facilities, i.e. visual acuity measurement, slit lamp biomicroscopy of the anterior and posterior eye segments, direct and indirect ophthalmoscopy. In most patients (72.6%) visual acuity was decreased due to macular pathology, especially age-related macular degeneration (AMD)--736 eyes (72.9%). Less common were degenerative myopia (10%), idiopathic macular hole (8.4%), epiretinal macular fibrosis (5.1%), and secondary macular changes of vascular, traumatic, or inflammatory genesis (3.6%). In 76.6% of eyes with macular pathology ophthalmoscopy was perfectly feasible and could be performed by a local ophthalmologist. Only in 23.4% of cases there was a dense posterior capsule opacification or nuclear cataract that impeded visualization of macular structures. The main reason for misdiagnosis of macular pathology and referring the patient to cataract surgeon was the neglect of apparent discordance between visual acuity and lens transparency. One should aim at adequate assessment of macular zone by all means, including non-contact ophthalmoscopy with 60 or 90 D aspherical lenses or Hruby lens and red-free examination.