Eyeworld

meibography summit: Better understanding of meibomian gland dysfunction and how to integrate meibography in diagnosis and treatment planning 2 | SUPPLEMENT TO EYEWORLD | SEPTEMBER 2019 of blinking, Dr. Cochener- Lamard said. Some assert that the in- creasing prevalence is related to greater awareness of MGD. "There are many risk factors, many unidentified, and we are learning more and more about what is causing MGD and certainly the prevalence," said Sumit "Sam" Garg, MD. MGD in optometry "MGD is one of the leading causes of contact lens intoler- ance," said Alice Epitropou- los, MD. 7 "The contact lens indus- try reports that 16–18% of contact lens patients drop out per year," said Douglas Devries, OD. Therefore, he said, it is important to recog- nize that a high percentage of patients dropping out of contact lenses have MGD, and earlier detection and treat- ment may reduce dropout. Younger patients Cynthia Matossian, MD, encouraged clinicians to look for MGD in younger patients. "The average age for our cataract surgery patient is decreasing, so MGD is being observed in younger and younger patients," she said. Gupta et al. found that 42% of children age 4–17 had meibomian gland atrophy. 8 Summit participants said potential causes include digital devices and poor diet. In ongoing research, Gupta et al. found that body mass index in children is correlated with meibomian gland tortuosity but not with meibomian gland atrophy. "It is not surprising that we did not see something relating to atrophy because children were in the study and perhaps atrophy has not had time to develop," said Preeya Gupta, MD. "But I think nu- trition plays a significant role in this disease." Participants emphasized that clinicians cannot afford to overlook MGD, which may or may not have symptoms or staining. "This is such a preva- lent condition that eventually, if cataract/refractive surgeons are not proactively assessing and treating their patients for this condition prior to surgery, they will run the risk of an unexpected and suboptimal refractive outcome, especially with toric and/or presbyopia- correcting IOL technology," said Terry Kim, MD. n References 1. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–1677. 2. Nichols KK, et al. The internation- al workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52:1922– 1929. 3. Craig JP, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017;15:802–812. 4. Lemp MA, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31:472–478. 5. Gupta PK, et al. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44:1090–1096. 6. Cochener B, et al. Prevalence of meibomian gland dysfunction at the time of cataract surgery. J Cataract Refract Surg. 2018;44:144–148. 7. Korb DR, et al. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc. 1980;51:243–251. 8. Gupta PK, et al. Prevalence of meibomian gland atrophy in a pediatric population. Cornea. 2018;37:426–430. continued from page 1 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 providership 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 protocols 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 Sur- gery 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 FDA or have been approved by the FDA for specific uses. Claiming Credit To claim credit, participants must visit bit.ly/2Nb7t11 to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be mailed or emailed 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 February 29, 2020. CME credit will not be awarded after that date. Financial Interest Disclosures Frank Bowden, MD, is a member of the speaker's bureau and has received travel support from Bausch + Lomb, Kala, Shire, and Sun Pharmaceuticals. Béatrice Cochener-Lamard, MD, PhD, has received a retainer, ad hoc fees, or other consulting income from Alcon, Cutting Edge, Hoya, Johnson & Johnson Vision, Santen, Thea, and Carl Zeiss Meditec. She has received research support from Alcon, Cutting Edge, Johnson & Johnson Vision, Santen, Thea, and Nutriceuticals. She has received a retainer, ad hoc fees, or other consulting income from Allergan, Bausch + Lomb, EyePoint, Johnson & Johnson Vision, Kala, Omeros, Physician Recommended Nutriceuticals, and Shire. She is a member of the speaker's bureau for Allergan, Bausch + Lomb, BioTissue, Johnson & Johnson Vision, NovaBay, Omeros, Physician Recom- mended Nutriceuticals, and Shire. She has received research support from Bausch + Lomb, Johnson & Johnson Vision, and Kala. Marjan Farid, MD, has received a retainer, ad hoc fees, or other consulting income from Kala. She is a member of the speaker's bureau for BioTissue. She has received a retainer, ad hoc fees, or other consulting income and is a member of the speaker's bureau for Allergan, CorneaGen, Johnson & Johnson Vision, and Shire. Sumit Garg, MD, has received a retainer, ad hoc fees, or other consulting income from Johnson & Johnson Vision, Kala, OcyTrx, RxSight, RySurg, Shire, SightLife, VisionCare, and Carl Zeiss Meditec. He is a member of the speaker's bureau for Johnson & Johnson Vision and Shire. He has an investment interest in OcyTrx and RPS. Preeya Gupta, MD, has received a retainer, ad hoc fees, or other consulting income from Alcon, Allergan, Aurea, Bausch + Lomb, BioTissue, Johnson & Johnson Vision, Kala, NovaBay, Ocular Science, Shire, TearLab, and Carl Zeiss Meditec. Carl Zeiss Meditec. She has received travel support from Alcon. Douglas Devries, OD, has an investment interest in RPS and Ophthalmic Resources. He has received travel support from Johnson & Johnson Vision. He has received a retainer, ad hoc fees, or other consulting income from Allergan, Sun Pharmaceutical, BVI, TearLab, RySurg, Science Based Health, Avellino, Eyevance, Kala, and Johnson & Johnson Vision. He is a member of the speaker's bureau for BioTissue, Science Based Health, and Johnson & Johnson Vision. Eric Donnenfeld, MD, has received a retainer, ad hoc fees, or other consulting income from AcuFocus, Alcon, Allergan, Bausch + Lomb, Beaver-Visitec, Elenza, CRST, Foresight, Icon Biosciences, Johnson & Johnson Vision, Kala, Katena, Lacripen, Merck, Novaliq, Odyssey, Omega Ophthalmics, and Oys. He has received a retainer, ad hoc fees, or other consulting income and has received research support from Eyepoint. He has an investment interest in, has received a retainer, ad hoc fees, or other consulting income from, is a member of the speaker's bureau for, and has received research support from AqueSys, AcuFocus, Avedro, Elenza, Glaukos, Lacripen, LensGen, Mati Pharmaceuticals, Mimetogen, NovaBay, Ocuhub, Pogotec, RPS, Sarcode, Strathspey Crown, TearLab, TrueVision, Veracity, Versant Ventures, and Visionary Ventures. Alice Epitropoulos, MD, has an investment interest in Eyevance, NovaBay, and Physician Recommended

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