Eyeworld

C OCTOBER 2025 | EYEWORLD BONUS ISSUE | 9 About the physicians Larissa Gouvea, MD, PhD Assistant Professor of Ophthalmology Storm Eye Institute Medical University of South Carolina Charleston, South Carolina George O. Waring IV, MD, FACS Waring Vision Institute Mt. Pleasant, South Carolina The tear film's optical power T he importance of the tear film cannot be overstated. As Vance Thompson, MD, EyeWorld Refractive Editorial Board member, says to patients, "the tear lens is 2–4 times more powerful than the implant I'm going to put in your eye." He tells his patients that the tear film is like "the blood of our cornea" and that it's the "best anti-red, anti-itch drop there is … and we want more of it." While ophthalmologists look at the tear film as a therapeutic issue, Dr. Thompson says it's equally an optical one. Larissa Gouvea, MD, PhD, said the impor- tance and contribution of the tear film to the optical system is not given the attention it's due. "While surgeons using premium and presby- opia-correcting IOLs are more mindful of the contributions of the tear film to optical quality, it is still underweighted in many preop work- flows," Dr. Gouvea said. "This leads to avoidable postoperative dissatisfaction. However, more often we have seen the literature give more im- portance to the ocular surface, and I think this is key to improving our understanding of the tear film optics and improving our outcomes." George O. Waring IV, MD, FACS, thinks that while the contributions of the tear film to the optical system are appreciated by eye surgeons, it's poorly understood in the general population. "There's a wonderful opportunity for education of the public of the importance of a healthy ocular surface," Dr. Waring said. "The vast majority of our patient population presents with dry eye of some form. Not only is there an opportunity to educate the general population on the importance of the tear film and a healthy ocular service as it relates to visual function but also in terms of the prevalence of dry eye and the etiology of dry eye." An abnormal tear film can cause foreign body sensation, fluctuating vision, contact lens intolerance (Dr. Waring noted that contact lens use also contributes to an abnormal tear film), poor quality of vision, and inaccurate IOL power calculations, to name a few. Dr. Waring said many patients are surprised when they're diagnosed with dry eye. "We have not done a good enough job educating the public on what the most common symptoms of dry eye are," he said. "Historically, I think that the dogma has been that your eyes hurt or the eyes feel dry, but we think that the most common symptom, which is often over- looked, is vision fluctuation." He said an example of this is the patient who wakes up in the morning and tries to read their phone but can't see clearly until they blink several times. Similarly, after a long day at work, Dr. Waring said patients like this can't adequately see the TV without blinking sever- al times. Dr. Waring said he experienced this transient vision himself a few years ago. He, Dr. Gouvea, and colleagues studied it, performing double-pass wavefront on a series of patients with various stages of dry eye. 1 They observed and published a correlation between retinal image quality and dry eye severity. "Often those patients will be 20/20 in clinic but complaining they can't see well," Dr. Gouvea by Liz Hillman Editorial Co-Director continued on page 10 Tear film analysis software of the iTrace; A) eye with abnormal tear film and dense staining inferiorly and centrally; B) tear film analysis of the same eye showing overall poor tear film quality evidenced by low tear film index (0.8) and irregular Placido generated topography Source: Victoria Fernandes, MD, cornea research fellow, Medical University of South Carolina

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