Clinical and economic impacts of optical coherence tomography prior to cataract surgery in a low-to-middle-income country

Background 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. Objective This study aimed to evaluate these impacts by prospectively recruiting 225 patients, aged 71 ± 6 years, from two ophthalmology surgical centers in Almaty, Kazakhstan. Methods Patients undergoing phacoemulsification of cataracts with monofocal intraocular lens (IOL) implantation between January 2022 and December 2023 were divided into two groups: the OCT group (n=75) received pre-operative OCT, while the Control group (n=150) did not. Visual acuity (VA) was measured pre- and post-surgery, and the cost-effectiveness of the surgical strategies was analyzed. Results 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) = 396.5, p< 0.001). Additionally, pre-existing concomitant diseases were diagnosed in 24.8% of cases in the OCT group and 31% in the Control group. Conclusion The economic analysis revealed that the integration of OCT facilitated combined surgical procedures during a single operative session, 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.