Eyeworld

I n ophthalmology, we are beginning to understand the importance of and adopt point-of-care testing. Decision- making in every other specialty is predicated on objective testing. When we have the opportunity to present information that changes the way ophthalmologists practice, I think it's an eye-opening event. Point of service testing is a dynamic way to improve patient care. The 2013 ASCRS Clinical Survey results provided feedback on dry eye and tear film diagnostics. Responses indicated that in cataract surgery cases, 21% of patients present with at least level 2 ocular surface disease, meaning that they need more than artificial tears. For laser vision correction, this number is about 24%. We need to be treating our pre-surgical patients more aggres- sively to improve outcomes. Dry eye is the single most com- mon reason that patients come into our office. It's estimated that 50% of the patients that come into our office have some form of dry eye disease, so this makes it the most important diagnosis we make. Managing dry eye is a stepwise progressive process, and there are a lot of interesting therapies. Even better, there are many new therapies that are being developed. like tear breakup time (TBUT) and supravital staining, which are more than 50 years old. Current options for the tear film have changed dramatically over the last several years and have expanded to include topography/OCT, osmolarity, MMP- 9 and lactoferrin levels and interfer- ometry. We need to be more cost effective in our practices and see patients more efficiently. I think that these new point of service diagnostic tests will be helpful. Dr. Donnenfeld is clinical professor of ophthalmology at New York University. He can be contacted at ericdonnenfeld@gmail.com. by Eric D. Donnenfeld, MD Ocular surface diagnostics: Then and now Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this course will: • Describe the levels of patients presenting with symptomatic and asymptomatic ocular surface disease before refractive and cataract surgery, and discuss the impact of this on visual quality and patient satisfaction outcomes; Eric D. Donnenfeld, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, AcuFocus, Alcon Laboratories Inc., Allergan, AqueSys, Bausch & Lomb, Elenza, Glaukos Corporation, Kala Pharmaceuticals, LacriSciences LLC, Mati Pharmaceuticals, Mimetogen Pharmaceuticals, NovaBay Pharmaceuticals, Ocular Therapeutix, Odyssey, SARCode BioScience, TearLab Corporation, TearScience, and WaveTec Vision Systems. He is a member of the speakers bureau of Alcon and Allergan, and has received research funding from Bausch & Lomb, Elenza, Ocular Therapeutix, and WaveTec. He has an investment interest in Glaukos, LacriSciences, Mati, Mimetogen, NovaBay, SARCode, Strathspey Crown, TearLab, TrueVision Systems, and WaveTec. Developing the latest point of care ocular surface testing protocol: Making advanced decisions from advanced diagnostics There are a number of diagnostic tests currently available to evaluate the tear film. Source: 2013 ASCRS Clinical Survey • Review the steps involved in new ocular surface protocols that incorporate advanced tear film testing into the point of care, including alterations to patient flow and impact on quality of care, patient satisfaction and chair time; and • Identify the new ocular surface diagnostic data that is being used to implement modern ocular surface disease treatment decisions. Designation Statement The American Society of Cataract and Refractive Surgery designates this live educational activity for a maximum of 0.5 AMA PRA Category 1 Credits.™ Physicians should claim only credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants must visit bit.ly/1pBVyTa to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Post-test must be faxed to the number indicated for credit to be awarded. When downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through December 31, 2014. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220. This CME supplement is supported by unrestricted educational grants from TearLab, TearScience, Rapid Pathogen Screening, and Nicox. Of those responding to the survey, 82% agreed or strongly agreed that dry eye patients take more time to manage in their practices. We're going to show you how to reduce the time, give your patients great care, and make them happier. Eighty-six percent agreed or strongly agreed that mild to moderate dry eye significantly affects postoperative satisfaction in cataract and refractive patients. By improving the ocular surface, we become better surgeons. The progression of ocular surface diagnostics has changed little over time until recently. The Schirmer's test was invented in 1904. This progressed to options Supplement to EyeWorld July 2014 EW Ocular care Supplement July 2014-DL2_Layout 1 6/30/14 8:59 AM Page 51

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