Eyeworld

C ORNEA 18 | EYEWORLD BONUS ISSUE | OCTOBER 2025 by Ellen Stodola Editorial Co-Director About the physicians Preeya K. Gupta, MD Managing Director Triangle Eye Consultants Raleigh, North Carolina Christopher Starr, MD Director, Refractive Surgery Director, Ophthalmic Education Weill Cornell Medicine New York Presbyterian Hospital New York, New York A s physicians continue to deal with dry eye and ocular surface disease, knowing treatment options that are available and appropriate steps to take for these patients is critical. Several years ago, the ASCRS Cornea Clinical Committee decided to take this on as a primary educational initiative because of lack of aware- ness and consensus regarding recommendations on ocular surface and dry eye disease. The Committee created the ASCRS Preoperative OSD Algorithm. 1 Preeya Gupta, MD, an author on the origi- nal paper and a member of the ASCRS Cornea Clinical Committee, said that the Committee is currently working on an update to the ASCRS Preoperative OSD Algorithm. Newer therapies for dry eye disease have been introduced. "We also want to focus on bringing education and awareness of this disease and its negative im- pact on outcomes in refractive cataract surgery," she said. The Committee is currently drafting its up- dates, with a planned webinar on these updates early next year closer to publication. EyeWorld has previously covered this topic and the ASCRS Preoperative OSD Algorithm and recently recapped presentations from a 2024 EyeWorld Corporate Education event in its Summer 2025 issue. One of these presentations from Christopher Starr, MD, gave an overview of the algorithm. The ASCRS Preoperative OSD Algorithm functions as a flow chart to guide ophthalmol- ogists through the testing, diagnostics, and treatment of visually significant OSD preopera- tively. The goal was to create an algorithm that was consensus- and evidence-based, that could be integrated into the preoperative surgery visit, that had reliance on technicians and objective testing to reduce surgeon chair time, and that would identify all visually significant subtypes of OSD, not just dry eye disease, prior to surgery. The algorithm involves a number of steps. The first step is to acquire the non-invasive refractive and biometric measurements, with the caveat that these tests might need to be repeated at a subsequent visit if visually signifi- cant (VS)-OSD is detected. For cataract surgery, these may include optical biometry, keratome- try, tomography/topography, etc., and for laser vision correction, aberrometry, tomography, etc. The second step is the OSD screening battery, with the goal of identifying all subtypes of OSD. This led to defining the term VS-OSD, or any OSD that can lead to IOL errors or Updates expected for the ASCRS Preoperative OSD Algorithm Upper eyelid collarettes located at the base of the eyelashes; these are suggestive of Demodex blepharitis, one type of VS-OSD Source: Beeran Meghpara, MD

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