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Correlation analysis between OCT evaluation and postoperative visual prognosis of patients with age-related macular degeneration complicated with cataract

BMC Ophthalmology volume 25, Article number: 266 (2025) Cite this article

Abstract

Objective

To explore the correlation between optical coherence tomography (OCT) evaluations and postoperative visual prognosis in individuals with AMD complicated with cataract, and to investigate the clinical applications of these evaluations for predicting visual outcomes.

Methods

We retrospectively analyzed the clinical data of 132 individuals (132 eyes) with AMD complicated by cataract, admitted to our hospital from April 2022 to January 2024. All patients underwent surgical treatment and were categorized into two groups based on their visual prognosis after 6 months: the “good prognosis (GP)” group (best corrected visual acuity decrease < 0.1 logMAR) and the “poor prognosis (PP)” group (best corrected visual acuity decrease ≥ 0.1 logMAR). We evaluated OCT parameters including central retinal thickness (CRT), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and total average macular thickness (TR). Pearson correlation analysis was employed to assess the relationship between these OCT parameters and postoperative visual outcomes. Additionally, receiver operating characteristic (ROC) were used to calculate the predictive value of OCT measurements for identifying poor postoperative visual prognosis in this patient cohort.

Results

Preoperative OCT results showed significantly higher values for CMT, CRT, TR, and SFCT in the PP group compared to the GP group (P < 0.05). Pearson correlation analysis revealed a positive association between postoperative visual acuity and these OCT parameters. Logistic regression modeling identified CMT, CRT, TR, and SFCT as key predictors of poor visual prognosis in AMD patients with cataract. ROC analysis showed that combining these parameters improved the prediction accuracy, with an area under the curve (AUC) of 0.993, sensitivity of 99.87%, and specificity of 95.30%, which were significantly higher compared to single-index evaluations (P < 0.05).

Conclusion

CMT, CRT, TR, SFCT are obviously related to the postoperative visual prognosis in patients with AMD complicated by cataract. The combined evaluation of these OCT parameters demonstrates high predictive efficiency for poor postoperative visual prognosis and can serve as an important assessment index for evaluating the postoperative visual prognosis in this patient population.

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Introduction

According to the data of the National Bureau of Statistics, by the end of 2022, the number of visually impaired individuals in China had reached 28.565 million. Age-related macular degeneration (AMD) with cataract are major contributors to blindness and vision loss among the elderly population [1]. The co-occurrence of age-related cataract and AMD is becoming increasingly prevalent, with age being a significant factor contributing to these complications. This dual affliction not only heightens the risk of vision loss but also profoundly impacts patients’ quality of life and mental well-being [2, 3]. Optical coherence tomography (OCT), a significant advancement in ophthalmic imaging, has emerged as indispensable tool for diagnosing and monitoring various ocular conditions. Due to its non-invasive nature and high-resolution imaging capabilities, OCT is particularly valuable in evaluating macular degeneration and cataracts, thus informing clinical management and treatment strategies [4, 5]. However, challenges persist in effectively utilizing OCT to predict postoperative visual recovery in complex clinical scenarios involving concurrent age-related cataract and AMD. The specific utility of OCT in forecasting visual outcomes and its optimal integration into clinical decision-making frameworks remain topics requiring further investigation. Recent advancements in cataract surgery, particularly the introduction of femtosecond laser-assisted cataract surgery and the use of high-end intraocular lenses, have markedly enhanced surgical safety and effectiveness. These innovations promise to improve patient outcomes, but further study is required to completely comprehend how OCT can be leveraged to optimize clinical decisions and predict postoperative recovery [6]. The existence of AMD may affect the visual recovery after surgery, especially the function and structure of macular area have an important impact on the prognosis [7]. Therefore, an in-depth analysis of the correlation between OCT evaluation results and postoperative visual prognosis of patients with AMD complicated with cataract is of great clinical significance and application value for guiding clinicians to formulate personalized surgical plans and predict the surgical effect of patients. This study’s objective is to systematically examine the correlation between OCT evaluation results and postoperative visual prognosis in patients with AMD complicated by cataract. The purpose of this research is to explore the clinical application value of OCT in this context and provide a scientific basis for optimizing treatment strategies for elderly patients with these eye diseases.

Research objects and methods

Research objects

General information

Clinical data from 132 patients (132 eyes) diagnosed with AMD complicated by cataract, who were admitted to our hospital from April 2022 to January 2024, were retrospectively analyzed. All patients underwent surgical treatment and were categorized into two groups based on their visual prognosis at the 6-month follow-up: the good prognosis (GP) group, defined as having a decrease in best-corrected visual acuity (BCVA) of less than 0.1 logMAR, and the poor prognosis (PP) group, defined as having a decrease in BCVA of 0.1 logMAR or greater. Written informed consent was obtained from all participants prior to their enrollment in the study. This study was approved by the Scienee and Technology Ethical Committee, approval number KJ2025-297 - 01 and conducted in accordance with the principles outlined t in the Helsinki Declaration.

Inclusion and exclusion criteria

Inclusion criteria: 1) Diagnosis of both AMD and age-related cataract based on established criteria [8, 9]. 2) Patients undergoing their first phacoemulsification combined with intraocular lens implantation. 3) Availability of detailed and clear OCT examination data prior to the operation. 4) Age ≥ 60 years. 5) Monocular cases only. Exclusion criteria: 1) Presence of other ocular diseases such as glaucoma, uveitis, idiopathic choroidal neovascularization, or other eye diseases. 2) Significant dysfunction of vital organs, including heart, liver, kidney, or spleen. 3) Retinal vein occlusion. 4) Complications with hematological disorders, autoimmune diseases, and malignancies. 5) Clinical evidence of vitreous macular traction. 6) Follow-up duration of less than 6 months. 7) Presence of cognitive impairment, language dysfunction, or psychiatric disorders. 8) Significant refractive errors, defined as a spherical equivalent ≥ − 6.00 diopters (D) for myopia, ≥ + 3.00 D for hyperopia, or astigmatism ≥ 3.00 D, which may adversely impact visual acuity and postoperative outcomes.9) Patients with coexisting ocular diseases such as glaucoma, uveitis, or idiopathic choroidal neovascularization. 10) Patients with significant dysfunction of vital organs or complications related to hematological, autoimmune, or malignant conditions.

Methods

Before the operation, all patients underwent OCT examination using the DRIOCT Triton OCT instrument from Beijing Topcon Medical Equipment Co., Ltd. The scanning parameters were set as follows: scan speed of 20,000 A-scans/s, axial resolution of 6μm, and 3D mode. The optic disc, measuring 3.4 mm in diameter, was in the center of the 512 × 128 pixel scanning range. If necessary, mydriasis was induced with compound tropicamide eye drops (Shenyang Xingqi Eye Drops Co., Ltd., 5 ml, National Medicine Standard Name: H20055546) to ensure clear fundus images. The measurements were performed between 9:00 and 11:00 AM, with each parameter recorded three times and averaged. All examinations were conducted by the same experienced ophthalmologist. Central macular thickness (CMT), central retinal thickness (CRT), total average macular thickness (TR), and sub-foveal choroidal thickness (SFCT) were observed and recorded in detail.

Surgical procedure

The eye to be operated on was selected based on the preoperative assessment of visual acuity, the severity of cataracts, and the overall clinical condition of the patient. In cases where both eyes had significant cataract formation, the eye with worse visual acuity or greater impact on daily activities was chosen for surgery. If there was no significant difference in visual acuity, the surgeon made the decision based on factors such as the degree of cataract maturity, lens opacity, and any associated ocular conditions.

Phacoemulsification combined with intraocular lens implantation was performed under sterile conditions. Prior to surgery, mydriasis was induced using compound tropicamide eye drops. After routine disinfection, a small incision was made at the corneal margin, and a viscoelastic agent was injected. The anterior capsule was opened, and the intraocular lens was placed in the capsular bag. The incision was then closed, and postoperative treatment included the application of eye ointment and dressing.

Evaluation criteria for poor prognosis of postoperative vision

The individuals were investigated for 6 months in the outpatient clinic after operation, and the follow-up deadline was July 30, 2024. After treatment, the patients; vision continued to deteriorate, and the best corrected vision decreased by ≥ 0.1 logMAR, which was judged as PP. After treatment, the visual acuity improved or did not deteriorate, and the best corrected visual acuity decreased by < 0.1 logMAR, which was judged as a GP.

Statistical method

Prism9 image processing was used for image analysis, and SPSS26.0 software was used for data analysis. The variance homogeneity test and normal distribution test were performed on the measuring data. If the data met the assumptions, comparisons were made using the independent sample t-test, and results are presented as mean ± standard deviation (SD). For counting data, the χ2 test was used, and results were expressed as [n (%)]. The relationship between the OCT examination outcome and postoperative visual prognosis was analyzed using Pearson correlation analysis. The predictive value of the OCT findings for poor postoperative visual prognosis in AMD patients with cataract was assessed using the receiver operating characteristic curve (ROC). A statistically significant difference was considered when P < 0.05. The sample size of the study was 132, ensuring sufficient power for statistical analysis.

Results

Comparison of two groups of general data

The age, sex, education background, place of residence, payment method of medical expenses, smoking, drinking, long-term medication, course of disease, intraocular pressure, hypertension, diabetes, hyperlipidemia, coronary heart disease, self-care situation and affected eye area of the two groups shown in Table 1 which illustrates that the general statistics for the two groups are similar (all P> 0.05)

Table 1 Comparison of two groups of general data
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Comparison of preoperative OCT evaluation results between the two groups

Preoperative OCT examination results were compared between the PP group and the GP group. The PP group had higher preoperative values for CMT (322.70 ± 44.55 μm), CRT (487.31 ± 53.31 μm), total TR (269.55 ± 35.04 μm), and SFCT (335.71 ± 43.55 μm) compared to the GP group, which had values of CMT (233.52 ± 32.77 μm), CRT (322.85 ± 41.97 μm), TR (269.55 ± 35.04 μm), and SFCT (275.52 ± 36.81 μm). Statistical analysis revealed significant differences between the groups (t = 11.530 for CMT, 16.934 for CRT, 4.802 for TR, 7.199 for SFCT; all P < 0.05), as seen Fig. 1. We show the details of OCT evaluation results between the two groups in Table 2.

Fig. 1
figure 1

Comparison of preoperative OCT evaluation results between the two groups (* P < 0.05)

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Table 2 Comparison the details of preoperative OCT evaluation results between the two groups (\(\overline{x} \pm s\))
Full size table

Correlation analysis between OCT evaluation results and postoperative visual prognosis

The poor postoperative visual prognosis of individuals with AMD and age-related cataract was positively correlated with CMT, CRT, TR and SFCT (all P< 0.05), as shown in Table 3 and Fig. 2.

Table 3 Correlation analysis between 3OCT evaluation results and postoperative visual acuity indexes
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Fig. 2
figure 2

Correlation analysis between 3OCT evaluation results and postoperative visual prognosis

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Evaluation value of OCT evaluation results on postoperative visual prognosis

With the prognosis of poor vision as the dependent variable (yes = 1, no = 0), meaningful independent variables CMT, CRT, TR, SFCT (original value brought in) in OCT evaluation results were incorporated into the logistic regression model for calculation. In addition, the formula logit (P) = 1/(1+eY) of the joint regression model was constructed. Y= constant (12.574) +OR value (2.147) ×CMT+ OR value (5.174) ×CRT+ OR value (4.369) ×TR+ OR value (3.740) ×SFCT. ROC curve analysis results indicate that, with the optimal cutoff values for CRT (397.71 μm), CMT (304.27 μm), total TR (262.03 μm), and SFCT (292.29 μm), the joint assessment predicted poor postoperative visual prognosis in individuals with AMD complicated by age-related cataract with an AUC of 0.993. The sensitivity of this combined approach was 99.87%, and the specificity was 95.30%, which was significantly higher than the specificity achieved with single-index assessments, however, caution should be exercised in interpreting these findings, as the difference may not be statistically significant when compared to CRT alone (P < 0.05). These findings are detailed in Table 4 and Fig. 3.

Table 4 Evaluation value of OCT evaluation results for postoperative visual prognosis
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Fig. 3
figure 3

The evaluation value of 4OCT evaluation results for postoperative visual prognosis

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Discussion

AMD mainly affects central vision, while cataract affects the clarity of the whole visual field [10, 11]. The prevalence of these two diseases is increasing year by year, which has a considerable influence on the quality of life of individuals [12]. OCT is a non-invasive imaging technique that provides high-resolution cross-sectional images of the retina and macular area. This capability is invaluable for evaluating and monitoring conditions in patients with AMD and cataract [13, 14]. OCT provides detailed quantification of parameters such as CRT and the structure of the retinal inner layers, which are closely associated with visual prognosis [15]. In the case of AMD with cataract, the visual prognosis of patients may be affected by both. Therefore, investigating the correlation between OCT-derived parameters and postoperative visual prognosis in individuals with AMD complicated by cataract is essential for predicting surgical outcomes, formulating personalized treatment plans, and enhancing visual rehabilitation for these patients. OCT plays a significant part in evaluating the causes of low vision after cataract surgery and can help to understand the causes of low vision after cataract surgery [16]. Additionally, OCT also shows its importance in the analysis of therapeutic response of neovascular AMD and related factors affecting visual prognosis [17]. These studies provide a scientific basis for further exploring the correlation between OCT parameters and visual prognosis of patients with eye diseases.

Pearson correlation analysis showed that the poor postoperative visual prognosis of patients with AMD complicated with age-related cataract was positively correlated with CMT, CRT, TR and SFCT, indicating that the increase of CMT, CRT, TR and SFCT increased the risk of poor postoperative visual prognosis of patients. The fovea maculata is the most sensitive region of the retina, and an increase in its thickness often indicates edema or inflammation in the macular area [18,19,20,21]. Previous studies have documented pathological changes in the macular region of patients with AMD, including retinal pigment epithelial cell dysfunction, photoreceptor cell damage, and vitreous floaters [22]. When surgical intervention is performed in patients with age-related cataract, mechanical trauma to the macular region may occur, potentially exacerbating macular foveal edema and negatively impacting postoperative visual recovery. Preoperative CMT has been associated with poor postoperative visual outcomes, highlighting its importance as a predictive indicator for visual recovery following cataract surgery [23, 24]. Additionally, CRT represents the overall thickness of retina, and its increase in CRT often correlates with pathological conditions such as macular edema, inflammation, and retinal vascular abnormalities [24]. The formation of choroidal neovascularization in patients with AMD can lead to retinal edema and CRT increase [25]. In the process of cataract surgery, the operator may pull and compress the retina to some extent, which will aggravate retinal edema and lead to unsatisfactory postoperative vision recovery. Another study found that CRT prior to surgery significantly impacts postoperative vision recovery in cataract patients [26]. TR represents the ratio of the thickness of the retinal neuroepithelial layer to the retinal pigment epithelial layer [27]. In patients with AMD, photoreceptor cell damage frequently leads to thinning of the retinal neuroepithelial layer accompanied by thickening of the retinal pigment epithelial layer, thereby resulting in an increased TR value [28]. Cataract surgery can exacerbate damage to the retinal neuroepithelial layer, potentially leading to poor postoperative vision recovery. SFCT measures the thickness between sclera and choroid, and an increase in SFCT is often associated with pathological changes such as inflammation, edema, and neovascularization in these structures [29]. By integrating these parameters, the combined OCT model accounts for both the structural changes at the retinal and choroidal levels, providing a more nuanced view of AMD pathology and its potential impact on postoperative visual outcomes. These parameters are interrelated in AMD pathophysiology and thus complement each other when assessed together. The combination of CMT, CRT, TR, and SFCT enables a more robust prediction model by assessing both retinal thickness and choroidal health, which single-index models may overlook, leading to higher sensitivity and specificity in predicting postoperative visual prognosis. During cataract surgery, surgical manipulation of the sclera and choroid can induce increased tension and compression, thereby exacerbating inflammation, edema, and neovascularization within these tissues. These changes often contribute to suboptimal postoperative visual recovery. Prior studies have similarly demonstrated a correlation between SFCT and postoperative visual outcomes, consistent with the findings of the present study. Additionally, preparative OCT is crucial in cataract patients, as it identifies occult retinal pathologies undetectable by routine fundoscopic examination [30]. In early study, OCT revealed hidden retinal abnormalities in one out of seven patients who appeared normal in standard examinations. Early detection of conditions such as epiretinal membranes, age-related macular degeneration, and vitreomacular traction highlights the importance of incorporating OCT into the preoperative evaluation to ensure comprehensive patient assessment and optimal surgical outcomes.

The ROC curve analysis in this study revealed that the optimal cutoff values for CMT, CRT, total TR, and SFCT to predict poor postoperative visual prognosis in patients with AMD and age-related cataract were 304.27 μm, 397.71 μm, 262.03 μm, and 292.29 μm, respectively. The combined evaluation using these parameters achieved an AUC of 0.993, with a sensitivity of 99.87% and specificity of 95.30%, all surpassing those of single parameter evaluations. This indicates that a combined assessment of CMT, CRT, TR, and SFCT provides a more accurate prediction of poor postoperative visual prognosis, offering a valuable tool for clinical practice. Such a comprehensive evaluation enables a better understanding of the patient’s eye condition, facilitating personalized treatment strategies, reducing unnecessary surgical risks, and enhancing surgical outcomes. This study’s innovative approach of integrating multiple OCT parameters—CMT, CRT, TR, and SFCT—into a unified evaluation model is unique and offers robust data support for clinical prediction, filling a gap in previous research.

The limitations of this study are as follows: First, the sample size was relatively small, with only 132 patients included, which may limit the generalizability of the findings. The sample size in this study was determined based on the available cohort, but we agree that a larger sample would enhance the statistical power and provide more robust findings. A larger sample would also help to assess the stability and reliability of the predictive model across different patient subgroups. Future studies with larger sample sizes would enhance the representativeness and statistical power of the results. Second, the retrospective nature of the study introduces inherent biases in data collection and does not fully account for potential confounding factors, such as comorbidities and variations in postoperative care. Additionally, as a single-center study, there may be inherent biases related to patient selection, treatment protocols, and demographic characteristics that are specific to the institution. This could impact the external validity of the findings when applied to other populations or healthcare settings. A prospective, randomized controlled trial would provide stronger evidence to support the conclusions. Third, the follow-up period of 6 months is relatively short, restricting the ability to evaluate long-term outcomes and visual prognosis. To address this limitation, we recommend that future studies incorporate longer follow-up durations, ideally extending to 12–24 months or more, to better assess the long-term effectiveness and relevance of OCT parameters in predicting visual prognosis. Additionally, prospective studies with longer follow-up periods could help establish the long-term applicability and robustness of the proposed predictive model. Fourth, this study focused exclusively on OCT parameters and did not consider other factors that may influence visual recovery, such as inflammatory responses, lens positioning, or surgical techniques. Future research should include these variables for a more comprehensive assessment of visual prognosis. Lastly, although the predictive model demonstrated high accuracy, it lacks external validation. Testing the model on independent datasets in future studies would improve its generalizability and ensure its broader applicability across diverse populations. We believe that the findings, while based on a selective cohort, provide important insights into the predictive value of OCT for postoperative visual prognosis in AMD patients with cataracts. However, to enhance the external validity of these findings, future studies should consider relaxing some of these exclusion criteria, incorporating a more diverse patient population, and extending the research to multi-center settings. This would allow for broader applicability of the model to real-world clinical practice, including patients with multiple comorbidities and a wider range of ocular conditions.

In summary, CMT, CRT, TR, and SFCT are significantly correlated with the postoperative visual prognosis in patients with AMD and cataract. The combined evaluation of these parameters exhibits high predictive efficacy for poor postoperative visual outcomes, making it a crucial assessment tool for the clinical evaluation of visual prognosis of such patients.

Data availability

The simulation experiment data used to support the findings of this study are available from the corresponding author upon request.

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Authors and Affiliations

  1. Department of ophthalmology, The First Affiliated Hospital of Shihezi University, Xinjiang Uygur Autonomous Region, No.107 BeiNorth Road, Shihezi City, 832000, China

    Lei Zhang

  2. Department of ophthalmology, Chengdu Fifth People’s Hospital, Sichuan, 61000, China

    Yuanxiang Luo

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Contributions

Lei Zhang carried out study concepts & design, and manuscript editing; Lei Zhan contributed to clinical studies, data & statistical analysis; Lei Zhang and Yuanxiang Luo contributed to definition of intellectual content and data acquisition; Yuanxiang Luo were the guarantor of integrity of the entire study, helped to literature research and manuscript review.

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Correspondence to Lei Zhang.

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Ethics approval and consent to participate

This study was approved by the Scienee and Technology Ethical Committee, approval number KJ2025 - 297 - 01 and written informed consent was obtained from all participants.

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The authors declare no competing interests.

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Zhang, L., Luo, Y. Correlation analysis between OCT evaluation and postoperative visual prognosis of patients with age-related macular degeneration complicated with cataract. BMC Ophthalmol 25, 266 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12886-025-04094-9

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