Author’s Disclosure Block: Sarah Patterson, none; Davin Johnson, none; Tom Gonder, none

Abstract Body
Purpose: Routine use of corneal and retinal/optic nerve imaging is increasingly standard of care for patients undergoing consultation for cataract surgery, with prior reports indicating high disease detection rates. Our study assessed the effectiveness of these screenings in a Canadian population of patients undergoing consultation for cataract surgery. Study Design: This study is a retrospective chart review of500 consecutive patient eyes evaluated forcataract surgery between 2019 to 2023 at an independent health facility in Ottawa, Ontario. Patients were identified using billing data, with exclusions for those who opted out of research participation. The study aims to evaluate the incidence of preoperative abnormalities detected through imaging techniques that may not have been identified during clinical examinations. Ethics approval was obtained from the Queen’s University Health Sciences &Affiliated Teaching Hospitals Research Ethics Board. Methods: For all included patients, demographic data was collected, including gender, age, and the presence of ocular disease based on medical history or past clinical examination findings. Preoperative evaluation included Scheimpflug corneal tomography (Pentacam), OCT imaging of the optic nerve and retina, and clinical examination.Corneal tomography and macular OCT scans were reviewed by a cornea and retina specialist blinded to the examination results.The primary outcomes were the rate of clinically significant corneal and retinal abnormalities not previously detected or known before consultation. Secondary outcomes included the prevalence of clinically significant optic nerve head disease. Results: Excluding patients with a history of corneal/refractive surgery, corneal imaging detected irregular astigmatism in 33.4% (140/419) of patient eyes, with the most common phenotype being superior steepening.For patients with OCT imaging, macular abnormalities were detected in 8.1% (37/458) of eyes, with 3/458 (0.7% of all eyes) having potential impact on surgical outcomes. In all three of these cases the abnormality was detected only on OCT and not by clinical examination.In patients who had quality optic nerve head OCTs, 75.9% (289/381) of patient eyes had a normal average retinal nerve fibre layer thickness with 6.6% (25/381) of eyes having significant thinning. Conclusions: Routine use of corneal and retinal imaging for cataract surgery patients is important for helping guide IOL choice and providing better prognostic information to patients.nonetheless, our study found that the detection rate of clinically significant retinal disease, not otherwise detectable by clinical examination or prior diagnosis, was low.