Eyeworld

58 | EYEWORLD | DECEMBER 2021 R EFRACTIVE by Ellen Stodola Editorial Co-Director About the physicians Kourtney Houser, MD Duke University Durham, North Carolina Amir Marvasti, MD Coastal Vision Medical Group Irvine, California Vance Thompson, MD Vance Thompson Vision Sioux Falls, South Dakota vision is not good." Unfortunately, Dr. Hous- er said that outcomes of treatment for EBMD following cataract surgery may not be as good as if it was treated prior because "if you correct astigmatism with the irregular cornea, it's not always the right astigmatism." According to Amir Marvasti, MD, most patients with EBMD are asymptomatic. "Those who do present with vision quality complaints typically present for fluctuation in vision, dou- ble vision, or are sometimes being referred for a second or third opinion for dry eyes," he said. "It's crucial to have a high degree of suspicion for this condition for anyone who complains of blurry vision or fluctuation in their vision." Vance Thompson, MD, also encounters this epithelial blur problem frequently when dealing with EBMD patients. "The most powerful focus- ing element of the eye is the air/tear interface," he said. "In a normal cornea, the epithelium is relatively smooth, which promotes a smooth tear film and makes for a smooth air/tear interface and crisp vision. If the epithelium is irregular, the tear film is irregular and light rays are focused irregularly, and it creates reduction in image quality." E pithelial basement membrane dystro- phy (EBMD) can be seen in patients both prior to cataract surgery and after cataract surgery. Kourtney Houser, MD, said this is one of the more frequently diagnosed causes of blurry vision before or after cataract surgery, and it can be the result of long- term dry eyes. While common, EBMD is often missed, so it's important to look for it. "In all of my cataract evaluations, for people coming in with blurry vision, I always look for it, she said. "If I see it in the central 3 mm of the cornea, causing irregular astigmatism on topography, or see it in the center, I always treat before cataract sur- gery," she said, noting that patients might not notice a benefit when they still have a cataract. It helps the surgeon to know how much astig- matism to treat with cataract surgery, making patients happier postop, especially when using presbyopia-correcting lenses, Dr. Houser said. In addition to treating EBMD prior to cata- ract surgery, Dr. Houser said she gets a number of referrals for patients with blurry vision after cataract surgery. "I think a large percentage of people have undiagnosed EBMD and had a toric lens or multifocal put in and the quality of their Identifying EBMD: Looking for blurry vision and other signs Slit lamp photo showing central and paracentral map, dot, and fingerprint lines Epithelial map OCT demonstrating central and paracentral epithelial elevations and depressions

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