Eyeworld

C ORNEA 22 | EYEWORLD BONUS ISSUE | OCTOBER 2025 on the type of lens the patient is getting, Dr. Meghpara said. Dryness that's not addressed preoperative- ly can also affect the patient's quality of life postop. "If you have staining in the middle of the cornea or a rapid tear breakup time, pa- tients are not going to have the vision that they were hoping for. It's going to affect contrast. It's going to create glare, overall blurriness, and fluctuating vision that's worse at the end of the day. Overall, the quality of vision is not going to be good, and patients will look at your cataract surgery as a failure even though the surgery itself was perfect," Dr. Meghpara said. He emphasized the importance of preop education on the presence of dry eye before their cataract surgery, how if untreated preop it could affect their outcomes, and how if untreat- ed postop, it could affect their quality of vision and quality of life. Putting on his cornea specialist hat, Dr. Meghpara said no matter what subspecialty you are, the ocular surface may not be front of mind, but it should be on everyone's mind. "It's important to be aware that what I'm doing is probably going to impact the ocular surface and not in a negligible way," he said. This is espe- cially true for vision-preserving retinal injections or glaucoma drops, both of which can have a significant impact on the ocular surface. "Everyone has the same ultimate goal, which is to improve the overall health of the patient's eye. But it's a constant battle that, as these patients get older, is going to get more difficult to deal with," he said. The glaucoma perspective Reena Garg, MD, said the mindset regarding the ocular surface for glaucoma patients has changed over the years—even for herself. She recalled a patient she saw while in fellowship who was begging her fellowship director to put him on a different drop due to his ocular surface issues. "We were in the waiting room in front of all the patients, and he stopped her after his visit and said, 'Look at me.' She said, 'I'm sorry, we talked about this. Your pressure is good, and they don't make a preservative-free formu- lation.' I remember at the time thinking, 'His pressure is good; he should be happy he's not having a trabeculectomy or a shunt. He's one of the lucky ones, well managed on drops.'" That used to be the mentality, Dr. Garg said—your pressure is good, you're not going blind, so you have to deal with the side effects. The renaissance, as she put it, started 4–7 years ago. Not only did the COVID era have people looking at their screens, exacerbating dry eye problems, and looking at themselves more, but more alternatives for glaucoma treat- ments have entered the market, both as medica- tions and procedures. "We've shifted in that we have safer min- imally invasive surgeries. We have additional dry eye treatments that can combat some of the effects of the glaucoma medications that we're using. I do think that changes the way we think of glaucoma management now," Dr. Garg said. "Instead of committing patients to medications that we know are going to create ocular surface disease … we now have the flexibility to offer them other solutions, and we can think about the lifestyle component as actually important. … We can keep you under control and protect your optic nerve from glaucoma, but we also don't have to compromise on the physical attri- butes or feelings from being on drops." Dr. Garg said ocular surface disease should absolutely be accounted for when choosing glaucoma treatments for patients, while still pri- oritizing health of the optic nerve. Dr. Garg tries to partner with colleagues who have a specialty in dry eye as well as referring optometrists to have a synergistic, co-management relation- ship. This is beneficial both for more frequent pressure checks and dry eye management. Sometimes these patients are referred by the co-managing doctor back to her for a possible change in glaucoma treatment due to ocular surface intolerance. She finds this relationship helps prepare patients for more interventional glaucoma procedures. She said that while interventional glaucoma procedures can help patients reduce or elimi- nate drops, which can, over time, improve their ocular surface, sometimes these procedures immediately postop disrupt the ocular surface. "Often that's a delayed gratification [for dry eye relief]," she said. Dr. Garg said she does prescribe some anti-inflammatory drops and dry eye therapies, but she always tells her patients that they'd be better served by a specialist in this area. "I just dabble to help my patients because I don't want them to suffer," she said. continued from page 21

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