Eyeworld

88 | EYEWORLD | DECEMBER 2020 R EFRACTIVE Contact Brissette: asb9040@med.cornell.edu Ciralsky: jessciralsky@gmail.com Hatch: Kathryn_Hatch@meei.harvard.edu Trattler: wtrattler@gmail.com Is there a role for amniotic membrane placement in the treatment of ABMD? Dr. Brissette: I use this post-SK for EBMD with good results for corneal epithelial healing. Dr. Hatch: Yes, at the time of SK it could aid with epithelial recovery. It is not always covered by insurance. Dr. Ciralsky: There can be, although I do not routinely use it. What is your approach to a positive tear film osmolarity or InflammaDry (Quidel) with good, stable topography and biometry? Dr. Brissette: I'll often discuss the results with the patient because the OSD will worsen after cataract surgery. The surgery itself, the pre- scription drops, etc., can tip someone over to symptomatic OSD, so setting expectations prior to surgery is important. Dr. Ciralsky: If I see abnormal testing, I will pretreat the patient as cataract surgery will worsen the dry eye. Even with stable topogra- phy and biometry, I would pretreat and repeat measurements. Watch the full webinar at bit.ly/3crBwKl. Dr. Brissette: If they are not a RGP lens wearer and it's regular and stable, I'm OK with placing a toric. Dr. Hatch: If the astigmatism is regular, espe- cially in the central 4 mm, I am comfortable placing a toric IOL. I observe if they are correct- ing their astigmatism in spectacles and for what duration of time. If so, that may likely be a good sign for a toric IOL. If they required RGP for cyl- inder, I agree that a toric is not a good idea, and there is usually not a clear axis of placement for these eyes. Dr. Ciralsky: I am comfortable placing a toric if the astigmatism is regular in the central 4 mm zone. I avoid torics for irregular astigmatism or patients in RGP or scleral lenses. Do all of your patients get MMP and osmolarity testing or just premium IOL patients? Dr. Brissette: Our technicians ask dry eye ques- tions directly (i.e., fluctuating vision, discom- fort, tearing, etc.). If the patient endorses any of them, then we get the testing. Dr. Hatch: I perform LipiView [Johnson & John- son Vision] scans on all surgical preops. Dr. Ciralsky: I get testing on all patients with dry eye symptoms and on all premium IOL patients. I have had patients whose topogra- phies are still irregular postop s/p SK for Salzmann's nodules or EBMD. Would you repeat the SK? Dr. Brissette: Not if the pathology is no longer there. If the measurements are repeatable, I proceed. Dr. Hatch: It would depend if there is epithelial involvement to the ABMD and its location (if it is in the central 4 mm area or outside). If there are clear topographic changes and residual Salzmann's tissue to remove, a repeat SK could be done. The slit lamp exam would assist in de- ciphering whether it is superficial or if stromal scarring is also a factor. Dr. Ciralsky: I would repeat the SK if the irregularity is attributable to residual EBMD or Salzmann's nodules, which can be identified on slit lamp examination. Relevant disclosures Brissette: Alcon, Bruder, Carl Zeiss Meditec, Eyevance Ciralsky: Bruder Hatch: None Trattler: None Take-home pearl If you had to pick one pearl from this webinar, what would it be? Dr. Brissette: For me, it would be the num- ber of patients who are asymptomatic for OSD who have signs, which is why clinical examination along with point-of-care test- ing and other diagnostics have become so vital to the workup. Dr. Hatch: Take the time to look at the ocu- lar surface and use topography in all cata- ract evaluations (even when not covered by insurance) to help with your decision-mak- ing process. Dr. Ciralsky: Take time to evaluate the ocular surface before cataract surgery. Pre- treating existing conditions will improve bi- ometry and ultimately patient outcomes. continued from page 86

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