Eyeworld

N EWS 20 | EYEWORLD | JULY 2019 by Liz Hillman EyeWorld Senior Staff Writer DEWS II, among others), new diagnostic tools, and new FDA-approved medications and pro- cedural treatments. This, along with the rise in patient expectations with cataract and refractive surgery, new surgical technologies, and new IOLs and refractive procedures, has made it increasingly difficult for busy surgical practices to manage both simultaneously." Dr. Starr said the ASCRS Preoperative OSD Algorithm aims for seamless integration into the preoperative refractive and cataract surgical patient visit and relies heavily on technician performed objective testing to reduce chair time. The algorithm and proto- col guides the work- flow and assists the surgeon in establishing signs and symptoms of OSD, determining visual significance, and treating all OSD sub- types appropriately. Dr. Starr pointed out that the protocol as published is not the only way, nor is it a new universal standard of care that every practice must meet. As such, it was created to be adaptable based on practice resources, equip- ment, and established preoperative visit flow. If a practice doesn't have tear osmolarity, MMP-9, or other newer point-of-care OSD testing, the ASCRS SPEED II preoperative OSD question- naire developed to go with the algorithm along with the "look, lift, pull, push" exam cost noth- ing and can lead to increased awareness and diagnosis of visually significant OSD, Dr. Starr said. Though, he noted, the ASCRS Corneal Clinical Committee's consensus is that osmolar- ity and MMP-9 testing are essential components of the OSD screening battery. "Any abnormality on any portion of the essential screening battery makes a diagnosis O phthalmologists, in general, are aware of the impact the ocular surface can have on refractive out- comes, but ASCRS Clinical Surveys have revealed a disconnect between that knowledge and putting it into action to improve outcomes. New information and guidelines, a slew of diagnostic options, and a plethora of treatment modalities have made addressing the ocular surface to improve outcomes overwhelming, so the ASCRS Cornea Clinical Committee stepped up to the task. The ASCRS Preoperative OSD Algorithm was published with the May 2019 issue of the Journal of Cataract & Refractive Surgery 1 and was widely dis- cussed at the 2019 ASCRS ASOA Annual Meeting. "A vast majority of respondents [to the ASCRS Clinical Surveys] thought a novel diagnostic and treatment algorithm, tailored to the needs of busy cataract and refractive surgeons, would be useful, so we created one," said Christopher Starr, MD, who took the lead on this project with the ASCRS Cornea Clinical Committee. The ASCRS Preoperative OSD Algorithm functions as a flow chart to guide ophthalmolo- gists through the testing, diagnostics, and treat- ment of visually significant OSD preoperatively. Dr. Starr said that when he and the clinical committee set out to create the tool, it "seemed like an easy job at first." He quickly learned it was "more complicated than I ever imagined." "But that actually speaks to the education- al gaps we aimed to address," Dr. Starr said. "Managing DED and OSD in the modern era is complicated because the field has exploded with new publications (CEDARS DTS paper, TFOS Contact information Starr: cestarr@med.cornell.edu ASCRS Cornea Clinical Committee develops preop OSD guidance tool continued on page 22 About the doctor Christopher Starr, MD Associate professor of ophthalmology Director of the Refractive Surgery Service Director of ophthalmic education Weill Cornell Medicine New York Reference 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. Financial interests Starr: Allergan, Novartis, Alcon, Shire, Bruder, TearLab, Quidel, Kala Pharmaceuticals, Novaliq, Sun Pharmaceutical, BlephEx, Eyevance Pharmaceuticals, EyePoint Pharmaceuticals, Dompé "A vast majority of respondents [to the ASCRS Clinical Surveys] thought a novel diagnostic and treatment algorithm, tailored to the needs of busy cataract and refractive surgeons, would be useful, so we created one." —Christopher Starr, MD

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