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Contact information Name: JUNE 2019 | EYEWORLD | 3 by Clara Chan, MD EyeWorld Cornea Editor positive corneal staining, 63% had an abnormal tear breakup time of less than or equal to 5 seconds, and 18% had Schirmer's score with anesthesia of less than or equal to 5 mm. 1 Gupta et al. looked at 120 consecutive patients pre- senting for cataract surgery evaluation and found that 80% had at least one abnormal tear test (osmolarity or MMP- 9). 2 A couple of recent publications have reshaped how dry eye disease is defined and understood. The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop II (DEWS II) report was published in 2017. 3 In last month's Journal of Cataract & Refractive Surgery, the ASCRS Cornea Clinical Committee presented an algorithm for the preoper- ative diagnosis and treatment of ocular surface disorders. 4 There will be more discussion about those recommenda- tions in an upcoming EyeWorld. Stay tuned. References 1. Trattler WB, et al. The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;11:1423–1430. 2. Gupta PK, et al. Prevalence of ocular surface dysfunc- tion in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44:1090–1096. 3. TFOS DEWS II. www.tfosdewsreport.org/report-tfos_ dews_ii_report/36_36/en/ 4. Starr CE, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45:669–684. P ractical diagnostic and man- agement strategies of dry eye are import- ant because all of us in ophthalmology see patients with either symptoms or signs of dry eye. More importantly, we all cause or exacerbate dry eye in our patients in our pursuit of helping them with other issues: We treat glaucoma with long-term eye drops, we perform intravitreal injections, we may render a cornea neurotrophic after a penetrating keratoplasty or more commonly, by per- forming cataract or refractive surgery. Some of us may be tempted to give a few bottles of artificial tear samples and hope they don't return. But given the chronic nature of dry eye disease, it is not a realistic strategy to hope some artificial tear samples will be satisfactory. Furthermore, the incidence of dry eye in patients undergoing cataract surgery in a real-world setting is higher than anticipated. Before continuing the conversation about dry eye developments in this month's In Focus series, it's important to keep the peer-reviewed literature in mind. Trattler et al. found in a prospec- tive study that of 136 patients scheduled to undergo cataract surgery, 77% had Dry eye developments ACRYSOF ® IQ TORIC IOL IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ Toric posterior chamber intraocular lenses are intended for primary implantation in the capsular bag of the eye for visual correction of aphakia and pre-existing corneal astigmatism secondary to removal of a cataractous lens in adult patients with or without presbyopia, who desire improved uncorrected distance vision, reduction of residual refractive cylinder and increased spectacle independence for distance vision. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Toric IOLs should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation. All viscoelastics should be removed from both the anterior and posterior sides of the lens; residual viscoelastics may allow the lens to rotate. Optical theory suggests that high astigmatic patients (i.e. > 2.5 D) may experience spatial distortions. Possible toric IOL related factors may include residual cylindrical error or axis misalignments. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof ® IQ Toric Cylinder Power IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof ® Natural IOL and normal color vision. The effect on vision of the AcrySof ® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS ® or BSS PLUS ® Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. © 2018 Novartis 7/18 US-TOR-18-E-1605 FACEBOOK @EyeWorldMagazine TWITTER EyeWorldMag INSTAGRAM @eyeworldmagazine eyeworld 24/7 YOUTUBE EyeWorldTV.com

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