Eyeworld

SEPTEMBER 2019 | SUPPLEMENT TO EYEWORLD | 11 be extremely significant, as it is in surgical and other areas as well." Regular gland expression Elizabeth Yeu, MD, recom- mended that patients have a lid evaluation and meibomian gland expression at least twice a year. "It is one thing if we perform a formal thermal pul- sation therapy once a year, es- pecially when you see architec- tural damage. But the biofilm that plugs the orifices, getting those open a minimum of twice a year I think helps with allowing for better egress with less pressure, which is only going to help the management of the MGD process." Marguerite McDonald, MD, recommended taking steps to remove the biofilm before thermal pulsation ther- apy. "We do blepharoexfoli- ation and thermal pulsation almost exclusively together, back to back," she said. She is collecting data on the impact of this protocol, but trends are showing that patients get 6 months of additional relief before it needs to be repeated. Comanagement recommendations Figure 2 shows how Summit participants instruct coman- aging clinicians regarding diag- nosis and treatment before referral. Figure 2. More than half of Meibography Summit participants who comanage cataract surgery instruct comanaging clinicians regarding diagnosis and treatment of MGD before referring patients. "Although we encourage it, not all referring optome- trists are identifying MGD and pretreating it before send- ing us their cataract patients," said Cynthia Matossian, MD. "We try very hard to edu- cate our OD community by providing lectures, inviting them to come and spend time with us, to see our different diagnostic and treatment tools in action. It is a continuum of training. Our goal is to get our comanaging ODs to identify, treat, and send us a tuned-up ocular surface." Douglas Devries, OD, agreed. "We discuss this with our referring doctors through education. We talk about it consistently, but unfortunately, it still is a fairly low percentage in which ocular surface dis- ease is identified and treated … before the referral." Technicians play an important role in alerting sur- geons to patients with signs of MGD who have not been diagnosed or treated before referral. "You have to train technicians to get you when they see abnormal values stacking up," Dr. McDonald said. "That way, you can go into the exam lane, examine the patient, and start treat- ment. You must explain that the rest of the cataract evalu- ation (dilated exam, biometry, topography, optical coherence tomography of the macula, etc.) will take place at the next visit," she said. n References 1. Gomes JAP, et al. TFOS DEWS II Iatrogenic Report. Ocul Surf. 2017;15:511–538. 2. Korb DR, et al. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc. 1980;51:243–251. For surgeons who comanage cataract surgery, do you routinely instruct your comanaging ODs/MDs to identify and treat MGD prior to referring the patient? No, I prefer to manage MGD in my clinic 6% Yes, sometimes 38% Yes, always 56%

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