Eyeworld

The importance of treating the ocular surface P rior to any cataract or re- fractive surgery, it's best to evaluate the patient's ocular surface first. The most prevalent ocular surface condition is dry eye dis- ease (DED), including aqueous deficient dry eye, evaporative dry eye, and meibomian gland dysfunction (MGD). In the 2018 ASCRS Clinical Survey, respon- dents reported that 39% of their DED patients have a mix of MGD and aqueous deficiency. Salzmann's nodular degeneration, anterior basement membrane dystrophy, and pterygium should also be considered. 1 These conditions may result in visual symptoms and affect corneal measurements, keratom- etry, and biometry. If a condi- tion is not addressed preop the distorted measurements can lead to a suboptimal outcome. In the ASCRS survey, 91% agreed or strongly agreed that mild to moderate DED signifi- cantly impacts satisfaction in cataract and refractive patients postop, and 93% agreed or strongly agreed that DED sig- nificantly impacts keratometry and IOL calculations. Literature resources The Tear Film Ocular Surface Society published DEWS I and II 2 and the Cornea External Disease and Refractive Society published their paper on DED. 3 Most recently the ASCRS Cornea Clinical Committee published its paper on the impact of evaluat- ing ocular surface disease (OSD), specifically in the preop cataract or refractive surgery patient, in- cluding "a new consensus-based practical diagnostic OSD algo- rithm designed to aid surgeons in efficiently diagnosing and treating visually significant OSD before any form of refractive surgery is performed." 4 The ASCRS algorithm The ASCRS Cornea Clinical Committee focused on the preop cataract and refractive surgery patient, rather than the gener- al DED population, because addressing OSD/DED relieves symptomatology and leads to a better outcome. The algorithm has a custom- ized SPEED 2 questionnaire. It includes the previously docu- mented SPEED 1 questions but specifically targets the preop pa- tient. The questionnaire discusses symptomatology and assesses character traits to help determine expectations and choose an IOL. The algorithm starts at the screening process, using informa- tion gained through the question- naire and results of osmolarity and MMP-9 tests, two DED point-of-care tests. It helps define a stepwise process to decide whether to delay surgery or to proceed. This algorithm should be a very relevant and clinically applicable tool that practices can implement. n References 1. Goerlitz-Jessen MF, Gupta PK, Kim T. Impact of epithelial basement mem- brane dystrophy and Salzmann nodular degeneration on biometry measure- ments. J Cataract Refract Surg. 2019 Aug;45(8):1119–23. 2. Jones L, et al. TFOS DEWS II man- agement and therapy report. The Ocular Surface. 2017;15;3;575–628. 3. Milner MS, et al. Dysfunctional tear syndrome: Dry eye disease and associ- ated tear film disorders—new strategies for diagnosis and treatment. Curr Opin Ophthalmol. 2017;27:Suppl 1:3–47. 4. Starr CE, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019 May;45(5):669–84. Dr. Kim is a professor of ophthal- mology at Duke University School of Medicine and chief of the Cornea and External Disease Division and director of Refractive Surgery Service at the Duke University Eye Center. He is also president-elect for ASCRS. He can be contacted at terry.kim@ duke.edu. Managing ocular surface disease in a preoperative cataract or refractive surgery patient ASCRS By Terry Kim, MD 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's 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 • Describe new and emerging technological advances for the treatment of presbyopia and the astigmatic presbyopic patient • Integrate proper patient education and conversation techniques for the astigmatic and presbyopic patient view the materials. CME credit is valid through May 31, 2020. CME credit will not be awarded after that date. Financial Interest Disclosures Kenneth A. Beckman, MD, has an investment interest in Avedro, Calhoun, Eyevance, EyeXpress, Ocular Science, and RPS. He has received a retainer, ad hoc fees, or other consulting income from Alcon, Allergan, Avedro, Bausch + Lomb, Bruder, EyeXpress, Kala, Mallinckrodt, Omeros, Refocus, Sun, and TearLab. He is a member of the speaker's bureau for Alcon, Allergan, and Carl Zeiss Meditec. He has received research support from Avedro, Icare, Kala, and Refocus. Clara C. Chan, MD, has received a retainer, ad hoc fees, or other consulting income from Allergan, Bausch + Lomb, Johnson & Johnson Vision, Labtician, Santen, and Shire. She is a member of the speaker's bureau of Alcon, Allergan, Labtician, Santen, and Shire. She receives research support from Allergan, Bausch + Lomb, and TearLab. Terry Kim, MD, has an investment interest in and has re- ceived a retainer, ad hoc fees, or other consulting income from Avellino, CorneaGen, Eyenovia, Kala, NovaBay, Ocular Therapeutix, Omeros, Presbyopia Therapies, and Simple Contacts. He has received a retainer, ad hoc fees, or other consulting income from Aerie Pharmaceutical, Alcon, Allergan, Avedro, Bausch + Lomb, Blephex, Dompe, Johnson & Johnson Vision, Shire, Sight Scienc- es, and Carl Zeiss Meditec. Elizabeth Yeu, MD, has an investment interest in Myno- sys Celluar Devices, Modernizing Medicine, and Ocular Science. She has received a retainer, ad hoc fees, or other consulting income from Alcon, Allergan, Aurea, Bausch + Lomb, BioTissue, BVI, EyePoint, GuidePoint, iOptics, Johnson & Johnson Vision, Kala, Merk, Mynosys, Ocular Therapeutix, OcuSoft, Omeros, Precision Lens, Science Based Health, Shire, TearLab, and Carl Zeiss Meditec. She is a member of the speaker's bureau for Alcon, Allergan, BioTissue, iOptics, Johnson & Johnson Vision, Shire, and TearLab. She has received research support from BioTissue, iOptics, Kala, Ocular Science, TearLab, and TopCon. Staff member Kate Fehlhaber, PhD, has no ophthal- mic-related financial disclosures. Supported by an unrestricted educational grant from Shire, Johnson & Johnson Vision, Allergan, and Sun Ophthalmics. Terry Kim, MD 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 de- vices 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/2CeMiTH to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with score of 75% or higher to earn credit. Alter- natively, the post-test form included in this supplement may be mailed or emailed 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

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