Eyeworld

SEPTEMBER 2022 | EYEWORLD | 67 C continued on page 68 The role of corneal imaging for IOL planning About the physicians Douglas Koch, MD Department of Ophthalmology Cullen Eye Institute Baylor College of Medicine Houston, Texas Kevin M. Miller, MD Kolokotrones Chair in Ophthalmology David Geffen School of Medicine at UCLA Los Angeles, California by Liz Hillman Editorial Co-Director C orneal imaging for IOL planning is vital, but what instruments to use and what the measurements from these different instruments inform varies. EyeWorld spoke with Douglas Koch, MD, and Kevin M. Miller, MD, to get their thoughts on corneal imaging as part of the preop planning process. What do you use? Every new patient in Dr. Koch's practice gets a Galilei (Ziemer) image. Dr. Koch said this device, which features Placido topography and dual Scheimpflug tomography, gives him the opportunity to assess the anterior surface using the Placido mires. The tomography contrib- utes corneal thickness data and if there is any evidence of ectasia. From there, if cataract surgery is scheduled, Dr. Koch said patients are prescribed an at-home treatment regimen of preservative-free tears, warm compresses, and lid scrubs before coming back for the preopera- tive visit with biometry readings. On the day of preop testing, two biometry readings are obtained, an IOLMaster 700 (Carl Zeiss Meditec) and a Lenstar (Haag-Streit). Dr. Koch said both of these contribute valuable corneal data. "We're using other devices as well, but those are our mainstays. Patients get three different measurements but on two separate occasions," Dr. Koch said. "You don't have to use three different devices, but it's nice to get at least two measurements, preferably with two different instruments and on separate days, so you get a sense if there are any ocular surface issues that are a concern." Dr. Miller also uses a number of different instruments. When selecting the spherical (Restasis [Allergan] or Cequa [Sun Pharmaceu- tical]) and topical lifitegrast (Xiidra [Novartis]). Dr. Bunya continued that no prescription eye drop has been proven to be superior over the others, so it's often a matter of trial and er- ror to find what works for specific patients. She noted that insurance coverage can be a hurdle. Both Dr. Bunya and Dr. Gupta discussed Tyrvaya (varenicline, Oyster Point), a nasal spray that stimulates the trigeminal nerve path- way for tear production. Dr. Gupta described how Tyrvaya not only stimulates the lacrimal gland but also causes contraction of the mei- bomian gland muscle and degranulation of the goblet cells, which produce mucin. "It's stimulating the complete tear. We like to think of this product as something that's trying to restore tear film homeostasis. When that happens, you're basically independent of the etiology, whether it's evaporative or aqueous deficient," she said. Dr. Bunya and Dr. Gupta also mentioned punctal occlusion or cautery. Dr. Gupta noted that plugs in the right person can be helpful, but they won't aid patients with evaporative dry eye or allergies. Other available treatments for aqueous tear deficient dry eye, Dr. Bunya said, include short courses of topical steroid drops; blood products, such as autologous serum eye drops; and scleral lenses. 'There is no cure' In the end, all the physicians interviewed for this article said the treatments for dry eye will need to be lifelong to maintain symptom relief. "There is no cure, and I'm very open with my patients. They need to understand that," Dr. Matossian said. "It is a chronic condition for which they will need treatment forever. Their symptoms will improve if they stay compliant with their daily regimen." Dr. Bunya said that while patients will likely be on some sort of treatment for life, once they find an effective regimen, it can greatly improve their quality of life. "In addition, dry eye has received increased interest from pharmaceutical companies in recent years, so I am hopeful that with more research, we will find more effective therapeutic options," she said. continued from page 66 BACK TO BASICS

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