Eyeworld

MAR 2015

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

Issue link: https://digital.eyeworld.org/i/474673

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167 March 2015 EW MEETING REPORTER Edward J. Holland, MD, Cincin- nati, and panelists Terry Kim, MD, Durham, N.C., W. Barry Lee, MD, Atlanta, and Elizabeth Yeu, MD, Norfolk, Va., discussed the man- agement of ocular surface disease, epithelial dystrophies and degener- ations, and endothelial disease in cataract patients and how to modify phaco techniques. When it comes to ocular surface and epithelial disease, the key is to treat the disease preoperatively, even if you have to delay surgery, Dr. Holland said. If you don't treat preop, you'll have an unhappy pa- tient, and you'll end up implanting the wrong IOL, Dr. Lee said. Abnormal keratometry can be a sign that you need to look closer at the slit lamp for ocular surface disease, Dr. Kim said. Rather than immediately look- ing at the cornea with a slit narrow beam and high magnification, use oblique illumination and a low mag- nification to get a good view of the ocular surface, Dr. Holland said. Dr. Holland pointed out that ocular surface disease due to meibo- mian gland dysfunction (MGD) is becoming an increasingly prevalent condition, and ophthalmologists need to address it. With less omega -3 fatty acids present in the diet, specialists now see MGD in much younger patients. "I think we're at a paradigm change in how important this diagnosis is," he said. Educating patients on the significance of MGD as well as educating clinicians on how to treat it has become a major focus. The first line therapy for MGD depends on the patient, Dr. Kim said. He will often start with lid hygiene and omega-3 supplements, and leave thermal treatments such as LipiFlow (TearScience, Morris- ville, N.C.) up to the finances of the patient. Dr. Yeu recommends that her MGD patients change their "lid ergonomics." "We don't have a really good blink even if we think that we're good blinkers," she said. With in- complete blinks and not squeezing the eye shut, there's not enough egress of lipid out of the meibomian glands, and that congestion leads to inflammation, she said. She recom- mends that patients perform blink exercises that are recommended post LipiFlow treatment as part of their lid routine. Topical azithromycin is an effec- tive treatment, Dr. Kim said, when rubbed on the eyelid/eyelash margin at night. Azithromycin is the antibi- otic of choice because it penetrates the lid margin better than bacitracin or erythromycin, Dr. Holland added. Anterior basement membrane dystrophy (ABMD) and Salzmann's nodules are 2 epithelial diseases that are often subtle and easy to over- look, and this is where topography becomes important, Dr. Lee said. "If on topography you see hot spots, flat spots, or missing spots, you should pay greater attention to the surface in those areas," Dr. Yeu said. It is also key to lift the upper lid to check for pathology when performing the exam, she said. ABMD can be easily overlooked when the tear film is flooded with fluorescein, Dr. Kim added. "It's very easy to miss on a clinical exam without staining, but you can still > No Capital Commitments, No Maintenance Costs > Reliable, Up-To-Date Equipment when you need it > Dedicated Onsite Support from Trained and Credentialed Technicians > Marketing Support Drives Patient Adoption and Practice Development The time to adopt Laser Cataract Surgery is NOW. CATALYS ® The Precision Laser System has gone Mobile. MobileCATALYS.com | 1.800.963.7101 continued on page 168

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