Eyeworld

Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint provid- ership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld magazine. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives • Describe the ASCRS Cornea Clinical Committee ocular surface disease algorithm for preoperative patients and its integration into surgical practices. • Implement more consistent practice pro- tocols for assessing lid and meibomian gland function and structure in order to proactively identify MGD signs and symptoms; review evidence for efficacy of therapies for MGD. • Appropriately pair treatment choices to severity and etiology of acute and chronic dry eye disease. Designation Statement The American Society of Cataract and Refractive Surgery designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses. Claiming Credit To claim credit, participants must visit bit.ly/2Im6Jk7 to review content and down- load the post-activity test and credit claim. He has financial interests with Takeda, Novartis, Johnson & Johnson Vision, Bausch + Lomb, TearLab, Alcon, and Eyevance. Christopher Starr, MD, has served as a consultant/advisor to Allergan, Alcon, Novartis, Quidel, TearLab, Shire, Sun, Bausch + Lomb, Kala, BlephEx, Eyevance, Eyepoint, Bruder, Dompe, and Novaliq. Staff member Jessica Donohoe has no financial interests to disclose. Supported by an unrestricted educational grant from Shire, Johnson & Johnson Vision, Sun Ophthalmics, and Allergan All participants must pass the post-activity test with score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be emailed or mailed in for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through December 31, 2019. CME credit will not be awarded after that date. Financial Interest Disclosures Marjan Farid, MD, has financial interests with Allergan, Shire/Takeda, Johnson & Johnson Vision, Kala, Eyepoint, Eyevance, CorneaGen, and BioTissue. Preeya Gupta, MD, is a consultant to TearLab and Johnson & Johnson Vision. Francis Mah, MD, received a grant from Allergan that was not related to this work. advancing surgical outcomes: Algorithm launches new era in preoperative OSD management Christopher Starr, MD Preoperative ocular surface disease algorithm introduced by Christopher Starr, MD Tool is designed to streamline preoperative ocular surface disease diagnosis and treatment A nnual ASCRS Clinical Surveys have shown that although members fully recognize the im- portance of a healthy ocular surface in obtaining accurate preoperative measurements and achieving optimal post- operative outcomes from anterior segment surgery, they are not sure how to incorpo- rate evolving knowledge about ocular surface disease (OSD) and advanced diagnostic tech- nologies and therapies into practice. To help surgeons navigate this process, the ASCRS Cor- nea Clinical Committee cre- ated a new consensus-based preoperative OSD algorithm (Figures 1 and 2). 1 With sensi- tive and specific new point- of-care diagnostics and better examination tools, we can target each OSD subtype and treat it separately, optimizing the cornea, tear film, and mea- surements before cataract and refractive surgery. Increased involvement of technicians, physician extenders To streamline the process, we combined preoperative tests with ocular assessments and extensively rely on the use of technicians and physician extenders. Focusing specifically on all subtypes of OSD (not just dry eye disease), the algo- rithm begins with refractive testing (e.g., optical biometry, keratometry, topography, etc.), followed by the essen- tial OSD screening battery, which technicians administer to every preoperative cataract and refractive surgery patient. Essential tests include the ASCRS SPEED II question- naire, tear osmolarity, and matrix metalloproteinase (MMP-9). The combination of tear osmolarity and MMP-9 provides an abundance of information about the health of the ocular surface. 2,3 In a large collaborative study we performed with continued on page 2 ASCRS Click to read and claim CME credit

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