EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/119916
A S C R S World view Ocular surface disease is important to all F or many years when the topic of ocular surface disease (OSD) came up, no one cared except for a small number of cornea specialists. This topic was of little interest to the remainder of ophthalmology as it was considered, pardon the pun, a little "dry" and insignificant. Those of us in the specialty of cornea and external disease always knew the importance of OSD: visual loss, chronic discomfort, and the effect on quality of Edward J. Holland, MD, EyeWorld cornea editor life. In addition, the prevalence of OSD is overwhelming with many studies estimating that half of the population over the age of 50 has some type of surface condition. Not only was there a lack of interest from clinicians, there was also apathy from industry. Topical cyclosporine remains the only prescription medication approved for the treatment of dry eye. In addition, there has been little in terms of diagnostics in OSD beyond Schirmer strips and topical stains. Then a peculiar thing happened with the interest in OSD. Surgeons began noticing the impact OSD had on their outcomes. First it was the refractive surgeons. The leading cause of patient complaints and visual loss after refractive surgery is aqueous tear deficiency (ATD) dry eye. Refractive surgeons quickly understood the value in diagnosing and aggressively treating dry eye. It was also understood that for some patients it was better to delay surgery and treat the dry eye first then to manage dry eye postoperatively. The next group of ophthalmologists interested in OSD was the cataract surgeons, especially with the advent of premium IOLs. Once again surgeons realized that OSD was the main cause of visual complaints postoperatively. In cataract patients meibomian gland dysfunction is the most common OSD, but ATD dry eye also is significant. Cataract surgeons had to understand how to diagnose and treat OSD if they were going to have successful outcomes. Finally, the glaucoma and even the retinal specialists realized that OSD played an important role in their patients' clinical course. Multiple topical glaucoma medications and neurotrophic changes of diabetes can be even more problematic with concomitant OSD. When the retina specialists are on board, then you know you have something. Interest in OSD has never been greater. Clinicians and industry alike are looking for new ways to detect the various causes of OSD, and many new treatments are on the horizon. In this issue of EyeWorld we discuss multiple new strategies to diagnose, manage, and prevent OSD. Changes in the formulation of existing topical medications to be more "ocular surface friendly" are discussed by Richard Lindstrom, MD, Rick Lewis, MD, and Eric Donnenfeld, MD. Several new OSD medications are in various stages of approval. Jay Pepose, MD, Robert Latkany, MD, and Vincent de Luise, MD, bring us up to date on these new therapeutic agents in development. Ike Ahmed, MD, Jeff Zink, MD, and Keith Warren, MD, discuss their approach to managing dry eye in glaucoma and retina patients. In addition we now have new technologies for diagnosing and treating OSD. Robert Sambursky, MD, Stephen Lane, MD, and Michael Lemp, MD, share their thoughts on the latest diagnostic devices as well as new therapeutic modalities in the treatment of ATD dry eye and MGD. It has been a long time in getting here, but OSD finally is being understood by all in ophthalmology for the significant impact it has on our patients. It is exciting to see new technologies for diagnosing as well as the many new treatment options coming in the near future. These new modalities will not only be of interest to cornea specialists but to all clinicians and most importantly to our OSD patients. Edward J. Holland, MD, EyeWorld cornea editor The official publication of the American Society of Cataract & Refractive Surgery April 2013 Volume 18 • No. 4 P U B L I S H I N G S TA F F Publisher John DiConsiglio don@eyeworld.org Matt Young Donald R. Long Editorial Editor Jena Passut jena@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Senior Staff Writer Erin Boyle erin@eyeworld.org Arlington, Virginia Malaysia Rich Daly Arlington, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 ellen@eyeworld.org 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Production Advertising Sales Graphic Designer Jeff Brownstein Julio Guerrero jeff@eyeworld.org julio@eyeworld.org 703-788-5745 Production Manager Paul Zelin Staff Writer Ellen Stodola Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Daniela Galeano daniela@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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