Eyeworld

Cornea It is surprising that 15% of respondents think that 0% of patients present with OSD preop- eratively. Another 40% of respondents think patients presenting preoperatively with OSD is 0–20%, which is extremely surprising given that studies have shown that the majority of patients in the preoperative setting have signs of dry eye disease or visually significant OSD. If you're not looking for it, you're not identifying it, and patients are not being appropriately treated preoperatively. Discussing if they'd implant a multifocal or EDOF IOL in a patient with signs of OSD, 18% of respondents said they'd do the surgery and treat after. This is a gamble because if you don't identify and treat OSD preoperatively, oftentimes your measurements will be wrong, so you'll have poor refractive outcomes and unhappy patients. The majority said they would treat and manage OSD preop and then implant the IOL once OSD was resolved, which is definitely more reasonable. If you're treating preoperatively, you're ensuring you'll have better measurements, and your measurements are more accurate. If you treat preoperatively, patient symptoms will be better managed, and patients are going to be educated on OSD with proper expectations. We still have a lot of education around diagnosis and treatment of OSD preoperatively that we can do. Respondents also answered if they are per- forming crosslinking, with 35% indicating they are, and 65% responding that they are not. We know that we can stop progression of disease with crosslinking. New advances, such as epi-on crosslinking, which just received FDA approval in October, are the future to be able to manage the disease for younger keratoconus patients who can have a drastically different outcome in long-term vision if they have crosslinking. Hopefully, we'll see that number rise as epi-on becomes available because it will carry even less risk of postoperative infections, and postoper- ative pain will be decreased. Epi-on could also open the door to comprehensive and refractive ophthalmologists being able to offer crosslinking for keratoconus patients without feeling like they must refer to a cornea specialist. —Marjan Farid, MD ASCRS Cornea Clinical Committee Chair pq Statistically significant difference between segments n=981 Are you currently performing corneal collagen crosslinking? CURRENTLY PERFORMING BY SEGMENT 2025 Practice location U.S. 28% International 30% Years in practice Early stage (0–5 years) 36% Mid-stage (6–10 years) 47% Late stage (11+ years) 34% Perform majority of surgeries in Hospital outpatient department 40% Office 44% Gender Male 36% Female 34% 35% Yes No 65% n=981 Would you implant a multifocal or EDOF IOL in a patient with treatable OSD signs? 18% I would implant and then manage OSD postoperatively I would treat and manage OSD preoperatively and then implant the IOL once the OSD was resolved 58% I would NOT implant a premium IOL 24% pq Statistically significant difference between segments n=981 What percentage of your patients present with OSD preoperatively? AVERAGE BY SEGMENT 2025 Practice location U.S. 33% International 33% Years in practice Early stage (0–5 years) 28% Mid-stage (6–10 years) 33% Late stage (11+ years) 31% Perform majority of surgeries in Hospital outpatient department 31% Office 26% Gender Male 30% Female 29% 30% Average patients presenting with OSD preop 0% 15% 28% 27% 17% 9% 4% 1–20% 21–40% 41–60% 61–80% 81–100%

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