Eyeworld

C OCTOBER 2025 | EYEWORLD BONUS ISSUE | 21 examine the patient's lids, conjunctiva, and ocu- lar surface, looking for tear instability and signs of inflammation. In addition to dry eye disease, they're looking for epithelial basement mem- brane dystrophy, Salzmann's nodular dystrophy, pterygia, and conjunctivochalasis. Drs. Kim, Li, and Shukla said they ask about a history of autoimmune conditions and prior contact lens use or laser refractive surgery like LASIK or PRK. "Treating these corneal patholo- gies prior to the cataract surgery is very import- ant because they can lead to postop refractive differences of 1 D or more," they noted. If ocular surface issues are identified, the physicians said they explain to the patient that they have two different conditions—the cata- ract and an ocular surface abnormality, both of which require treatment. "Some patients are surprised initially to find that these treatments can delay their cataract surgeries. In these cases, patient education is key to help them under- stand the goals and expectations of these ocular surface treatments from the start. Once the patients understand how and why these issues are treated, they will be much more willing to undergo the preoperative treatments for a few weeks to improve their outcomes and quality of life," they said. If ocular surface issues go unresolved, Drs. Kim, Li, and Shukla said it can significantly influence refractive outcomes after cataract surgery. "There are likely multiple reasons that these ocular surface issues are not fully addressed preoperatively. One is that these dis- eases present with varying signs and symptoms. The other is that there are no standardized diagnostic criteria for these conditions. But it is important for us to realize that not treating these conditions can lead to several unantic- ipated issues down the road. This includes patient dissatisfaction and worsening of certain conditions such as dry eye disease. It may even require additional postop visits to address these issues properly. Minimizing ocular surface issues will be beneficial to patients and improve their postoperative satisfaction and quality of life." Beeran Meghpara, MD, said that he thinks that while the impact of the ocular surface on cataract surgery outcomes is well known, it remains under treated. Dr. Meghpara ideally begins his examination of a cataract patient before they have any drops in their eye, looking at them in a systematic way similar to the flow of the ASCRS Preoperative OSD Algorithm. It takes about 30 seconds to go through the look, lift, pull, push portion of the examination prior to administering fluorescein staining. "I think this is one of the misconceptions. We've got this big algorithm … but it doesn't take a long time to go through it," he said. If you find dryness—and the reality is everyone has at least a little bit of dryness, Dr. Meghpara said—treatment is individualized based on the patient's level of dryness. We don't want the dryness getting worse after cataract surgery, and we want the patient to have the best IOL calculations, he said. He added that the cataract severity can in- fluence how long he'll treat the patient's ocular surface. "If they have a terrible cataract and can't see, it's restricting their lives, we want to get them rehabilitated more quickly," he said, noting that he may not strive for perfection in these cases but does want to see some kind of improvement. If a patient wants a multifocal or toric lens, he's more persistent at achieving a pristine ocular surface preop. The clinical im- pact of dryness on cataract outcomes depends continued on page 22 Lissamine green corneal and conjunctival staining in a patient with dry eye disease Source: Eric Donnenfeld, MD

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