Eyeworld

I MANAGING IRREGUR CORNEAS PRIOR TO CATARACT SURGERY N FOCUS 46 | EYEWORLD | NOVEMBER 2019 by Vanessa Caceres EyeWorld Contributing Writer This led the ASCRS Cornea Clinical Com- mittee to create an algorithm for the preop di- agnosis and treatment of OSD, published in the May issue of the Journal of Cataract & Refractive Surgery. 4 The one-page algorithm guides users through noninvasive objective refractive and OSD assessments, an evaluation of symptoms via a novel questionnaire, the use of additional tests when available, a brief, directed clinical exam called "Look-Lift-Pull-Push" (LLPP), and targeted treatments before scheduling surgery. "The ASCRS Algorithm is a novel stream- lined protocol for integrating OSD identifica- tion and management within the context of the standard preoperative refractive surgery patient visit," Christopher E. Starr, MD, said. "We cre- ated it with an emphasis on technician-driven, objective, in-office testing in order to ultimately reduce physician chair time and improve patient outcomes." "Whether one uses the algorithm faithfully, partially, or not at all, we recommend that all surgeons attempt to identify and address OSD before surgery," Dr. Starr said. "Failing to do so could result in a wide variety of complications and patient dissatisfaction." Initial dry eye/OSD assessment When honing in on DED symptoms, Dr. Mah starts out with a questionnaire. The algorithm shares a copy of the ASCRS SPEED II ques- tionnaire, but surgeons can use other question- naires that suit their needs, Dr. Mah said. Any N ow more than ever, cataract surgery has become a type of refractive sur- gery, with patients expecting excel- lent vision postoperatively, especially when they've invested in premium IOLs. Yet the presence of dry eye and/or ocular surface disease (OSD) can make this crisp uncorrected vision hard to achieve. "Dry eye and ocular surface disease are an epidemic in our current society," Marjan Farid, MD, said. "[They're] multifactorial and related to increased screen time, the environment, hor- monal impact, and ocular surgery. Being able to diagnose [dry eye and OSD] help to move the needle to treat these patients, especially because we offer premium cataract surgery now. Patients' expectations are to have sharp vision, and we can't have that without a pristine ocular surface." Although surgeons responding to ASCRS Clinical Surveys have acknowledged the impor- tance of diagnosing and treating dry eye disease (DED), the majority also have said they do not have a uniform way to diagnose and treat DED, Francis Mah, MD, said. In recent years, although other guidelines for DED have been created by the Tear Film and Ocular Surface Society, the American Acad- emy of Ophthalmology, and the CEDARS/ ASPENS group, 1-3 none of these have focused specifically on treating OSD and DED before cataract or refractive surgery, Dr. Mah said. Algorithm and surgeons address OSD, DED before surgery Dry eye inducing irregular astigmatism (over 2 D), topography showing areas of drop out and loss of data (white area) and irregularity of placido rings After treating DED, more regular topography and regular mires Source (all): Alice Epitropoulos, MD At a glance • Dry eye and OSD are common problems before cataract and refractive surgery. Addressing these problems can help patients obtain better vision through surgery. • A new algorithm developed by the ASCRS Cornea Clinical Committee addresses the diagnosis and treatment of DED and OSD preoperatively. • The goal of treatment is to have non-visually significant OSD or no OSD present at all preop. • Some patients may require treatment for DED even after surgery. Relevant financial interests Ayres: None Epitropoulos: AbbVie, Alcon, Allergan, AMO, Biotissue, Johnson & Johnson Vision, PRN, Shire, SUN, Takeda, TearCare, TearLab, TearScience Farid: Allergan, Bio-Tissue, CorneaGen, Dompe, Eyepoint, Eyevance, Johnson & Johnson Vision, KALA, Shire Mah: Avedro Starr: Alcon, Allergan, Blephex, Bruder, Dompe, Eyevance, Johnson & Johnson Vision, Kala, Shire, Sun, TearLab, Quidel

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