Eyeworld

advancing surgical outcomes: Algorithm launches new era in preoperative OSD management 6 | SUPPLEMENT TO EYEWORLD | JULY 2019 Cataract Refract Surg. 2015;41:1672– 1677. 5. Dell S. Cataract and Refractive Lens Exchange Questionnaire. Cataract & Refractive Surgery Today. Available at: crstoday.com/wp-content/themes/crst/ library/images/2017_revision_dell_ questionnaire.doc. Accessed April 30, 2019. 6. Lemp MA, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011;151:792–798.e1. 7. Sambursky R, et al. Prospective, multicenter, clinical evaluation of point- of-care matrix metalloproteinase-9 test for confirming dry eye disease. Cornea. 2014;33:812–818. Dr. Gupta is associate professor of ophthalmology, Duke Univer- sity Eye Center, Durham, North Carolina. She can be contacted at preeya.gupta@duke.edu. categories of OSD, such as eyelid malposition that leads to corneal surface degradation, dry eye disease (meibomian gland dysfunction or aqueous deficient dry eye), and irreg- ularities such as Salzmann's nodules, anterior basement membrane dystrophy, infec- tious or allergic conjunctivitis, and many others. OSD is designated as visually significant OSD (VS-OSD) or non-visually significant (NVS-OSD). 1 It is critically important to de- lay surgery and aggressively treat patients with VS-OSD because it can impact ker- atometry values. 4 Patients with corneal staining can have abnormal corneal topography. These are all pieces of data that we will use to develop our refractive plans and goals. Our ability to deliver on our prom- ises to patients becomes much more variable in patients with VS-OSD. If NVS-OSD is not impacting the corneal surface, it is unlikely to alter measure- ments, so we may not need to delay surgery. Conclusion The algorithm is easy to fol- low and integrate into prac- tice. Most steps of this new tool are performed by techni- cian staff, who can administer the questionnaire and perform preoperative testing. The surgeon performs the clinical examination and interprets the collected point-of-care testing data. n References 1. Starr CE, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45:669–684. 2. Trattler WB, et al. The Prospective Health Assessment of Cataract Pa- tients' Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;11:1423–1430. 3. Gupta PK, et al. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44:1090–1096. 4. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratom- etry for cataract surgery planning. J New system helps surgeons aggressively treat ocular surface disease before surgery I n the preoperative setting, it is essential to diagnose and treat ocular surface disease (OSD) quickly to reduce potential surgical delays and improve visual outcomes. The new ASCRS Preoper- ative OSD Algorithm pro- vides critical direction to help surgeons take decisive action against OSD before cataract and refractive surgery. 1 Aggressive approach Surgeons need to develop an aggressive, multifaceted treat- ment regimen for preoperative patients, which may include prescription medications and procedural interventions. Most OSD is visually signifi- cant OSD because of punc- tate staining of the cornea, which can affect vision quality and tear quality, the lipid layer, and tear breakup time. Tear film irregularities will result in higher-order aberrations. Patients with non-visually sig- nificant OSD may have signif- icant symptoms, but their tear makeup may be acceptable. However, we need to address their OSD based on symp- toms and signs because it will become visually significant without prompt treatment and may worsen after surgery. Patient education, using point-of-care test results and diagnostic imaging, is key in improving patient compliance. Patients should understand that their vision ASCRS Preoperative OSD Algorithm guides targeted, multifaceted treatment strategies by Marjan Farid, MD continued on page 7 continued from page 5 Marjan Farid, MD

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