Eyeworld

C ORNEA 20 | EYEWORLD BONUS ISSUE | OCTOBER 2025 by Liz Hillman Editorial Co-Director About the physicians Kenneth Beckman, MD Director of Corneal Surgery Comprehensive Eyecare of Central Ohio Westerville, Ohio Reena Garg, MD Visionary Eye Doctors Rockville, Maryland Su Jeoung Kim, MD Cornea Fellow Columbia University Irving Medical Center New York, New York Lance Kugler, MD Kugler Vision Omaha, Nebraska Lucy Li, MD Glaucoma Fellow Columbia University Irving Medical Center New York, New York Beeran Meghpara, MD Director of Refractive Surgery Co-Chief of the Cornea Service Wills Eye Hospital Philadelphia, Pennsylvania Aakriti (Aaki) Garg Shukla, MD, MSc Leonard A. Lauder Associate Professor of Ophthalmology Glaucoma Division Columbia University Irving Medical Center New York, New York T he ocular surface impacts many oph- thalmic subspecialties beyond cornea. Whether it's within refractive surgery or cataract surgery, glaucoma therapy or retina procedures, the ocular sur- face can affect outcomes and quality of life for patients being treated by these subspecialists. On the flip side, the procedures within these subspecialties can cause or exacerbate ocular surface issues themselves. Several anterior segment ophthalmologists spoke with EyeWorld about the ocular surface and how it relates to their subspecialty. The cornea perspective Awareness of the impact of ocular surface disease across the subspecialties has improved drastically in the last few decades, especially as more diagnostic capabilities and diverse treat- ment modalities became available, said Kenneth Beckman, MD. As the impact of the ocular surface on refractive outcomes of cataract surgery became more well known, especially with advanced- technology lenses, knowledge and subsequent treatments have trickled down the ranks from cornea specialists to cataract and refractive specialists. Dr. Beckman said that oculoplastics, glaucoma, and retina physicians are becoming more aware of how their medications and pro- cedures affect the ocular surface of patients. "From a plastic standpoint, they're do- ing a lot of lid lifts in one fashion or another. You're getting greater exposure and dry eyes," Dr. Beckman said. "With glaucoma, they're on multiple medications that can be toxic with prolonged use. They're having surgical proce- dures that are altering the surface. Those things all can lead to dry eye. With the retina special- ist, it's the same thing. These are patients who are getting multiple interventions—injections, vitrectomies—and you're altering the surface. All of those fields, while they're not necessarily dealing with visual acuity per se, are impacting visual acuity by impacting dry eye. "They may not even be managing the dry eye, but a lot of times they're seeing the patients far more often than the comprehensive ophthal- mologist who refers them out, so they're getting the complaints," he continued. "They have to be prepared to handle these patients because they're not going to want to keep sending them back to me." Here's Dr. Beckman's message, as a cornea specialist, to ophthalmologists in the other specialties: • Glaucoma: Consider SLT or another glaucoma intervention instead of another harsh drop. Consider preservative-free drops. • Retina: If you want the patient on a non-ste- roidal, consider bromfenac, which can be used less frequently and is less toxic on the surface, rather than ketorolac. If an antibiotic is needed, consider a lower toxicity drop such as gatifloxacin rather than combination drops such as neomycin/polymyxin. Newer treat- ments that could reduce injections, and thus the betadine prep, could be helpful as well. • Oculoplastic: In cases of blepharoplasty or ptosis repair, oculoplastic surgeons should mention to patients the dryness that may occur afterward due to increased surface exposure or an incomplete blink. Be conserva- tive with your surgery, especially in patients who have pre-existing dry eye. Patients with thyroid eye disease already might be suffering from exposure, and Tepezza (teprotumumab, Amgen) could be helpful. Dr. Beckman's general take-home points include: • Be aware of problems that you're not treat- ing and how your treatment could impact them. "If I sent a Sjögren's disease patient to a glaucoma specialist, I don't want you to do something to make their surface worse if it can be avoided." • Be aware in someone who doesn't have any underlying problems how your treatment could kickstart ocular surface issues. The cataract perspective Offering the cataract perspective, Su Jeoung Kim, MD, Lucy Li, MD, and Aakriti (Aaki) Garg Shukla, MD, MSc, together provided thoughts on the importance of the ocular surface. They said to pay close attention to the patient's ocular symptoms and complaints, such as that of intermittent blurry vision, burning, watering, or itching. The physicians said they Ocular surface considerations for (and from) different subspecialties

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