EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/119916
52 EW FEATURE February 2011 Dry eye/ocular surface April 2013 Managing continued from page 51 velopments and advances in the future in drug delivery options will eventually help these patients. Dr. Latkany believes it's a positive trend that there is more awareness now among all ophthalmic specialties about ocular surface complaints. "I think we're going in the right direction. We're doing a better job of developing products that are better tolerated," he said. Retinal concerns The challenges for retinal surgeons treating conditions such as CME are similar to those that glaucoma surgeons face. Although the medications used might be different, preservatives in medications like topical corticosteroids or nonsteroidal anti-inflammatory drugs can irritate the eye surface, Dr. Warren said. "If there's significant dry eye, I'll try to avoid preservative-containing medications," Dr. Warren said. He'll consider the use of Durezol (difluprednate ophthalmic suspension 0.05%, Alcon, Fort Worth, Texas), in which the preservative sorbic acid does not irritate the eye as much. He'll also consider using a periocular injection because that is not administered to the front of the eye. Dr. Latkany does not see many dry eye patients with CME, but he does see a good number with an aggravated ocular surface after anti- vascular endothelial growth factor injections for age-related macular degeneration. He believes these patients need more careful pre- and postop management of their ocular surface, much like what is done nowadays for refractive surgery and even cataract surgery patients. When to refer patients to another specialist In addition to medication management techniques, glaucoma and retinal surgeons often will manage dry eye symptoms with the use of artificial tears, punctal plugs, compresses for meibomian gland dysfunction, or with Restasis (cyclosporine, Allergan, Irvine, Calif.). Yet there comes a point where they may need to refer patients to corneal specialists. "If all of those things fail and there's another comorbidity like anterior basement membrane disease that a cornea specialist could help manage, referring them can be helpful," Dr. Zink said. "By optimizing treatment for those problems, it often enables patients to tolerate their topical medications." Dr. Warren will refer to a cornea specialist when ocular surface symptoms are persistent and do not change with any of his treatment maneuvers. Before a referral, he will try to keep patients on their medication but offer dry eye treatment. If there's still the occasional flare up, he'll encourage patients to stay on the medication but increase their use of artificial tears and perhaps add Restasis. If problems still persist, or if the patient has severe dry eye from the start, he'll consider another treatment approach or refer to a corneal specialist. EW Editors' note: Dr. Ahmed has financial interests with Alcon, AqueSys (Aliso Viejo, Calif.), Glaukos (Laguna Hills, Calif.), Ivantis (Irvine, Calif.), NeoMedix (Tustin, Calif.), and Transcend Medical (Menlo Park, Calif.). Dr. Latkany has financial interests with Alcon. Dr. Warren has financial interests with Alcon, Dutch Ophthalmic Research Center (Zuidland, the Netherlands), and Genentech (San Francisco). Dr. Zink has no financial interests related to this article. Contact information Ahmed: 416-625-3937, ike.ahmed@utoronto.ca Latkany: 212-689-2020, relief@dryeyedoctor.com Warren: kwarren@warrenretina.com Zink: 513-984-5133, jzink@cincinnatieye.com