Occult retinal abnormalities detected by routine optical coherence tomography in comprehensive eye examination : a clinic dataset

Abstract

Purpose: Optical coherence tomography (OCT) is a widely utilized ophthalmic imaging technique commonly used in clinical practice. The axial resolution of modern commercial OCT devices is at the micron level, facilitating the detection of retinal problems that may be unable to be detected in conventional dilated fundus examination (DFE). We evaluated the efficacy of integrating OCT as a routine ophthalmic procedure for identifying occult retinal abnormalities using a university clinical dataset. Methods: The University Optometry Clinic initiated routine OCT screening as part of comprehensive eye examinations at no additional cost in summer 2025. An ophthalmic assistant captured OCT images of patients aged 40 years or older under natural pupils before the optometrist consultation. A retrospective analysis was conducted based on these OCT images acquired with a concurrent review of electronic medical records. Results: Overall, 1398 patients underwent routine OCT examinations in two months. Thirty-two patients were excluded because of bilateral suboptimal image quality attributed to undilated pupils. The three most common occult retinal abnormalities not identified by conventional DFE but revealed by OCT were partial posterior vitreous detachment (81 patients, 5.9%), epiretinal membrane, ERM (46 patients, 3.4%), and peripapillary intrachoroidal cavitation (43 patients, 3.1%). Other abnormalities identified by OCT included pigment epithelial detachment, thin retinal nerve fiber layer, focal choroidal excavation (FCE), and idiopathic central serous chorioretinopathy (ICSC). A more serious abnormality included lamellar holes. Patients with ERM (p < 0.001) and lamellar hole (p < 0.001) were older than those without. FCE (p = 0.003) and ICSC (p = 0.009) were more commonly occurred in male. Conclusion: Some occult retinal abnormalities were identified using OCT alone, but not discernible by conventional DFE. These mild abnormalities were unlikely to have serious consequence which may not affect clinical management. OCT examination might not be regarded as a necessary routine procedure.