Eyeworld

45 EW FEATURE November 2018 • Improving the ocular surface for cataract and refractive surgeons with less efficacy. Dr. Sarkisian pro- jected that the combination of MIGS with sustained-release medications in the pipeline are going to change the conversation about glaucoma therapy as it pertains to the ocular surface. "These are such exciting times to be having this discussion about dry eye and ocular surface disease in glaucoma," he said. If a patient does not want to do a procedure to get off some or all of their medications, Dr. Sarkisian said ophthalmologists need to be more aggressive than just prescribing tears. Punctal plugs, anti-inflamma- tory medications, and more need to come into play. If the glaucoma spe- cialist wishes to offer the patient dry eye management, he said it is worth scheduling a separate office visit to address that issue alone. "It's a good idea to spend some time coming up with a long-term strategy to help manage this and have a separate visit to address that. I think that will tell the patient that this is serious," he said. "Usually, I refer them to one of my optome- trists or if severe, a cornea specialist to manage." Dr. Djalilian said the ideal would be for every glaucoma spe- cialist to be checking their patients for surface disease, to help avoid progression to more advanced, diffi- cult to treat stages, but, he acknowl- edged, this is time consuming and might not be realistic. "The real message is to be aware that chronic glaucoma medications can both exacerbate and induce ocu- lar surface disease, which occasional- ly can be vision threatening and not just symptomatically bothersome to the patient. Being aware of these and intervening earlier makes a dif- ference in the long-term outcomes," Dr. Djalilian said. EW Reference 1. Baudouin C, et al. Preservatives in eye- drops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29:312–34. Editors' note: Dr. Sarkisian has finan- cial interests with Allergan (Dublin, Ireland), Beaver-Visitec International (Waltham, Massachusetts), Alcon (Fort Worth, Texas), Glaukos (San Clemente, California), Katena (Denville, New Jersey), New World Medical (Rancho Cucamonga, California), Omeros (Seat- tle), Santen (Osaka, Japan), and Sight Sciences (Menlo Park, California). Dr. Farid has financial interests with Aller- gan, Shire (Lexington, Massachusetts), Johnson & Johnson Vision (Santa Ana, California), CorneaGen (Seattle), and Bio-Tissue (Miami). Dr. Djalilian has no financial interests related to his comments. Contact information Djalilian: adjalili@uic.edu Farid: mfarid@uci.edu Sarkisian: Steven-Sarkisian@dmei.org (800) 367-8327 DuPont, WA 98327 info@lacrimedics.com • www.lacrimedics.com ©2018 Lacrimedics, Inc. 1 ASCRS Clinical Survey 2015. Global Trends in Ophthalmology and the American Society of Cataract and Refractive Surgery. Don't let 41% of your patients with OSD go untreated, especially when they need something more than artifi cial tears. Lacrimedics' VisiPlug® is FDA approved for the treatment of the Dry Eye components of varying Ocular Surface Diseases (OSD) and to enhance the effi cacy of topical medications. VisiPlug® – Provides approximately 180 days of occlusion so you can better manage your patient's treatment plan. Don't let 41% of your 41% of refractive or cataract surgery patients have ocular surface dysfunction levels requiring some treatment beyond artifi cial tears! 1 0.4mm 0.5mm

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