Clinical and Economic Impacts of Optical Coherence Tomography prior to Cataract Surgery in a Low-to-Middle-Income Country

Integrating optical coherence tomography (OCT) into the pre-surgical stage of cataract management holds significant clinical and economic potential, particularly in low-to-middle-income countries like Kazakhstan. This study aimed to evaluate these impacts by prospectively recruiting 124 patients, aged 70±8 years, from two ophthalmology surgical centers in Almaty, Kazakhstan. Patients undergoing phacoemulsification of cataracts with monofocal intraocular lens (IOL) implantation between January and December 2022 were divided into two groups: the OCT group (n=75) received pre-operative OCT, while the Control group (n=49) did not. Visual acuity (VA) was measured pre- and post-surgery, and the cost-effectiveness of the surgical strategies was analyzed. The OCT group experienced a significantly greater improvement in VA (-0.647±0.232 logMAR) compared to the Control group (-0.543±0.244 logMAR), with a notable interaction between time and group (F(df) = 217.2, p < 0.001). Additionally, pre-existing concomitant diseases were diagnosed in 25.3% of cases in the OCT group and 28.6% in the Control group. The economic analysis revealed that the integration of OCT facilitated multiple surgeries in one appointment, thereby reducing overall costs. These findings suggest that implementing OCT in the pre-surgical stage of cataract management can significantly enhance visual outcomes and decrease the cost of ophthalmology services in Kazakhstan.