Eyeworld

OCT 2018

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: http://digital.eyeworld.org/i/1035656

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8 1. A 67-year-old woman presents for cataract surgery complaining of fluctuating vision. Her slit lamp exam reveals clear corneas with no fluorescein staining, an abnormal tear breakup time, and 2+ nuclear sclerotic cataracts. Which of the following tests would be the most helpful in diagnosing the etiology of her symptoms? a. Corneal topography b. Meibography c. Tear osmolarity/MMP-9 testing d. Glare testing 2. A 35-year-old Caucasian male presents with interest in refractive surgery since he can no longer tolerate contact lenses. He spends more than 9 hours a day on digital devices and has red eyes, blurred vision, dryness, burning, and irritation. Meibography shows more than 50% atrophy of his meibomian glands, osmolarity measures 328 OD and 318 OS, and expression is primarily paste-like or non-expressive. What treatment is best given his age and level of disease? a. Begin with artificial tears b. Warm washcloth for 10 minutes and dilute baby shampoo to clean the eyelids c. Thermal pulsation and at-home hydrating compresses, blepharoexfoliation with at-home lid scrubs, topical anti-inflammatory treatment (corticosteroids or lifitegrast or cyclosporine), and oral doxycycline d. Lid scrubs, artificial tears, and omega fatty acids 3. A 77-year-old patient presents for a cataract evaluation. Her main complaint is progressively worsening vision that is further decreased with driving and reading for prolonged amounts of time. Which is not a consideration for this preoperative evaluation? a. Corneal topography b. Advanced biometry c. Meibography d. Fluorescein angiogram 4. Which of the following is true regarding meibomian gland dysfunction? a. Pregnancy is a risk factor. b. Prostaglandin analog users are likely to have MGD. c. Meibomian gland structure and function are significantly aligned in patients with MGD. d. All MGD is obvious and clinically significant on examination. 5. A 62-year-old woman undergoes preoperative cataract surgery evaluation. Astigmatism on corneal topography measures 1.6 D at axis 85, whereas astigmatism on optical biometry measures 0.8 D at axis 117. Slit lamp examination reveals mild to moderate MGD with a rapid tear film breakup time. What would your next step be? a. Schedule a toric IOL to reduce the average astigmatism between optical biometry and topography b. Initiate lid hygiene and topical anti-inflammatory therapies to improve the ocular surface and ask the patient to return to repeat measurements c. Inform the patient that she is not a candidate for an astigmatism-correcting IOL d. Initiate artificial tear therapy and ask the patient to return 3 days later for repeat testing CME questions (circle the correct answer) To claim credit, please fax the test and fully completed form by March 31, 2019 to 703-547-8842, email to KSabol@ascrs.org, or mail to EyeWorld, 4000 Legato Road, Suite 700, Fairfax, VA 22033, Attn: October 2018 CME supplement ASCRS Member ID (optional): First/Last Name/Degree: Practice: Address: City, State, Zip, Country: Phone: Email: Please print email address legibly, as CME certificate will be emailed to the address provided. Copyright 2018 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or the publisher, and in no way imply endorsement by EyeWorld or ASCRS. To take this test online and claim credit, go to bit.ly/2Pfph7m, or complete the test below and fax, mail, or email it in. Meibography Summit: Translating knowledge into practice

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