Eyeworld

meibography summit: Better understanding of meibomian gland dysfunction and how to integrate meibography in diagnosis and treatment planning 10 | SUPPLEMENT TO EYEWORLD | SEPTEMBER 2019 Timing meibomian gland dysfunction treatments sensitive to visual fluctuations. "I like to treat patients preop- eratively," said Edward Hol- land, MD. "If patients have moderate to severe MGD, I may delay surgery, especially depending on the basis of visual needs and the patient's expectations." Corneal find- ings such as punctate epithe- lial keratitis will reduce the accuracy of IOL calculations and postoperative outcomes. "We will maximize MGD therapy and get the ocular surface as healthy as possible, repeat the IOL calculations, then perform surgery," he said. His approach is even more aggressive in corneal refractive surgery candidates. Based on meibomian gland expression, quality of meibum, clinical examination, and meibography, Dr. Holland differentiates whether the patient has mild, moderate, or severe MGD and develops a treatment plan. Terry Kim, MD, begins treating MGD when he sees truncation or dilation of the meibomian glands on meibog- raphy. "You don't want to wait until you get late-stage signs of gland atrophy," he said. Figure 1 shows how Meibography Summit partici- pants' practices correlate with guidelines from the Tear Film and Ocular Surface Society Dry Eye Workshop II, which advises that clinicians diag- nose and treat ocular surface disease (OSD) before making decisions for refractive or cataract surgery. 1 As in surgical patients, early diagnosis and treatment of MGD are critical in the optometric setting, particu- larly if it causes patients to stop wearing contact lenses. 2 "If you wait too long, it is very difficult to get a patient back into contact lenses, but if you catch them early, you can change that," said Paul Karpecki, OD. "If you allow patients to stay in lenses for another 3 or 5 years, the im- pact on the profession would Effective treatment before cataract and refractive surgery increases optimal outcomes O ptimal timing can make all the difference in effectively treating mei- bomian gland dysfunc- tion (MGD). Early treatment It is particularly important to promptly diagnose and treat MGD in patients who are receiving premium intraocular lenses (IOLs), which are more Figure 1. Most Meibography Summit participants follow the current guidelines for diagnosis and treatment of MGD before cataract surgery. "If you wait too long, it is very difficult to get a patient back into contact lenses, but if you catch them early, you can change that." —Paul Karpecki, OD The current global scientific and medical consensus guidelines (TFOS DEWS II) indicate that MGD should be identified and treated prior to surgical decision making in the cataract patient. Does your current medical practice reflect these guidelines? Yes, in all cases Yes, in most cases Yes, sometimes No 75% 19% 6% 0%

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