Eyeworld

Supported by an unrestricted educational grant from Shire, Johnson & Johnson Vision, Sun Ophthalmics, and Allergan JULY 2019 | SUPPLEMENT TO EYEWORLD | 3 or both should be performed after the LLPP examination to assess for corneal staining and tear breakup time. Interpreting results Surgeons analyze the data and findings generated from the algorithm and determine which OSD subtypes are pres- ent and how severe they are. A key highlight of the new algorithm is that it differ- entiates between visually sig- nificant OSD (VS-OSD) and non-visually significant OSD (NVS-OSD). 1 If NVS-OSD is identified, surgeons can proceed with surgery and the refractive measurements but should also counsel the pa- tient that it may worsen post- operatively and prophylactic treatment should be started preoperatively. In contrast, if VS-OSD is diagnosed, surgery is delayed until converted to NVS-OSD. We recommend that each subtype of OSD is treated ag- gressively, using a multifaceted treatment regimen to reduce delays in surgery. Treatment usually requires a combination of prescription medications (antibiotics, steroids, im- munomodulators, etc.) and procedural treatments (bleph- aroexfoliation, thermal pulsa- tion, punctal plugs, amniotic membrane, pulsed light, etc.) when multifactorial VS-OSD is present. 5–7 The patient typically returns 2 to 4 weeks after beginning treatment, and pre- operative measurements and OSD testing are repeated, fol- lowing the algorithm from the beginning. If OSD is resolved or the patient has NVS-OSD, we can finalize the refractive planning and proceed with surgery. Conclusion It is essential to pinpoint and treat OSD before re- fractive and cataract surgery to achieve the high-quality results patients expect. The stakes are high and tim- ing is very important. This algorithm, whether adopted faithfully or partially, will help surgeons navigate this com- plex process. 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. Lemp MA, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011;151:792–798.e1. 3. Sambursky R, et al. Prospective, multicenter, clinical evaluation of point-of-care matrix metalloprotein- ase-9 test for confirming dry eye disease. Cornea. 2014;33:812–818. 4. Gupta PK, et al. Prevalence of ocular surface dysfunction in patients pre- senting for cataract surgery. J Cataract Refract Surg. 2018;44:1090–1096. 5. Sheppard JD, et al. Effect of lotepre- dnol etabonate 0.5% on initiation of dry eye treatment with topical cyclosporine 0.05%. Eye Contact Lens. 2014;40:289–296. 6. Sall K, et al. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology. 2000;107:631–639. 7. Tauber J, et al. Lifitegrast ophthal- mic solution 5.0% versus placebo for treatment of dry eye disease: results of the randomized phase III OPUS-2 study. Ophthalmology. 2015;122:2423–2431. Dr. Starr is associate professor of ophthalmology, co-director of the cornea fellowship, and director of the refractive surgery service and ophthalmic education, Weill Cornell Medicine, New York Pres- byterian Hospital, New York. He can be contacted at cestarr@med. cornell.edu. Integrating the ASCRS Preoperative OSD Algorithm into surgical practice by Francis Mah, MD Surgical practices need to emphasize OSD management to staff T he new ASCRS Preoper- ative Ocular Surface Dis- ease (OSD) Algorithm is a proactive system that will produce a paradigm shift in the way we manage ocular surface disease (OSD) before cataract and refractive surgery (Figures 1 and 2). 1 This is a critical step. Research has shown that it is important to address OSD when performing cataract and refractive surgery. 2–4 If OSD is not diagnosed or poorly managed before cataract or refractive surgery is per- formed, visual outcomes may fall short of expectations. Furthermore, OSD can impact preoperative measure- ments. For example, Epi- tropoulos et al. reported that tear hyperosmolarity affects continued on page 4 continued from page 2 Francis Mah, MD

• Blank Page
• Blank Page (1)