Cataract surgery restores clarity to the optical path, but the final vision a patient achieves depends on the health of the retina — especially the macula, which delivers central, detailed vision. A cataract can hide macular problems on standard examination. At Suraj Eye Institute, optical coherence tomography (OCT) of the macula is part of our pre-operative assessment whenever indicated, so that surprises after surgery are avoided.

What is a Macular OCT?

OCT uses low-coherence near-infrared light to create cross-sectional images of the retinal layers at the back of the eye. The scan is:

• Non-contact — no dye injection, no touching of the eye
• Fast — a few seconds per eye
• Painless — you simply look at a fixation target
• Detailed — individual retinal layers and the foveal contour are visualised at micron-level resolution

What We Are Looking For

Epiretinal membrane (ERM)

A fine scar-like membrane on the surface of the macula. It can cause distortion, reduced vision, and often worsens after cataract surgery due to mild post-op inflammation.

Macular hole

A full-thickness or partial defect at the centre of the macula. Even a small hole has a major impact on vision and needs retinal surgical attention — ideally before or combined with cataract surgery in selected cases.

Diabetic macular oedema (DME)

Thickening of the macula due to diabetic retinal disease. If present, it should usually be treated (with anti-VEGF injections or focal laser) before cataract surgery, because cataract surgery can worsen DME.

Age-related macular degeneration (AMD)

Drusen, pigment epithelial changes, wet AMD — all detected clearly on OCT. Cataract surgery can still be done, but visual recovery will depend on the AMD status.

Cystoid macular oedema (CMO)

Sometimes present pre-operatively in diabetic, uveitic or post-retinal-surgery eyes. Detection allows pre-emptive treatment.

Myopic maculopathy

In highly myopic eyes, OCT can show macular schisis, myopic traction or foveoschisis — all of which affect prognosis.

Vitreomacular traction and adhesion

OCT reveals abnormal vitreous attachments that can worsen after cataract surgery if untreated.

When We Do Pre-op Macular OCT

At SEI we recommend macular OCT before cataract surgery in the following situations:

• Patients with diabetes — irrespective of known retinopathy
• Patients with known age-related macular degeneration or retinal disease
• Patients with high myopia (axial length > 26 mm)
• Patients considering a premium IOL (multifocal, trifocal, EDOF) — where the retina must be healthy for the IOL to deliver its designed benefit
• Patients with vision much worse than the cataract alone would explain
• Patients with previous retinal surgery, uveitis or laser
• Patients with metamorphopsia (visual distortion)

How Findings Change Our Plan

Treat first, then operate

If OCT shows active DME, wet AMD or an untreated macular hole, we usually treat the retinal condition first — for example with intravitreal anti-VEGF injections — and then proceed with cataract surgery once the macula is stable.

Change IOL choice

Multifocal and trifocal IOLs divide incoming light between distance and near focal points, which reduces contrast. In an eye with macular disease, this trade-off is usually unacceptable. We would recommend a monofocal IOL, EDOF in selected cases, or a monofocal plus glasses for near — and explain this clearly before surgery.

Set realistic expectations

Where the macula has fixed pre-existing damage, we tell you exactly what kind of vision is realistic after cataract surgery — the cataract can be removed and the optics improved, but vision will be limited by the retina. This honesty is fundamental to our practice.

Combine procedures

In selected cases, cataract surgery is combined with a macular procedure (e.g. phaco + vitrectomy for macular hole or ERM) in a single anaesthetic, reducing overall recovery time.

Frequently Asked Questions