Eyeworld

EW CORNEA 69 September 2014 The moment the pulse rate in refractive surgery is defined: VisuMax and MEL 80 With the MEL ® 80 excimer laser and VisuMax ® femtosecond system, ZEISS has assembled a seamlessly coordinated systems solution for refractive laser surgery. For everything from precise flap creation to highly accurate refractive corrections, these two top-of-the-line products are designed to ensure convenient workflow, streamlined patient management and excellent treatment results. Learn more about the power of precision and efficiency. Visit us at www.RefractiveFacts.com Carl Zeiss Meditec, Inc. 800 342 9821 www.meditec.zeiss.com VMX.6017 © 2014 Carl Zeiss Meditec, Inc. All copyrights reserved. "The TBUT is an essential and easily performed diagnostic test," Dr. de Luise said. It is important to do the test before any anesthetic drops are administered. The stan- dard for TBUT is variable but can be categorized as immediate, less than 5 seconds, and less than 10 seconds. "Repeated TBUT measurements of less than 5 seconds are diagnostic of ocular surface disease, but cannot distinguish ADED from EDED," Dr. de Luise said. An abnormal TBUT indicates that there is tear film in- stability or a dysfunction of tear film quality, usually due either to mucin or lipid phase abnormality, he said. Eyelid evaluation "The eyelids should always be evaluated," Dr. de Luise said. It is important to look for crusting or scaling, as well as to look at the meibomian gland orifices to check for any indication of posterior blepharitis, meibomitis, or MGD. He added that physicians should check if the meibomian glands are open or closed and the quality of the meibum. Look for telangiectasia on the eyelid margins, he added, be- cause this could be an indication of ocular or oculofacial rosacea, which is often associated with posterior blepharitis and MGD. When doing an eyelid evalua- tion, Dr. Perry said it's important to see if there is a full or partial blink, if the patient tends to stare, or if there is lid retraction. He also does a lid massage to examine the character of meibomian gland secretions. Delphi panel and other recommendations In 2006, the Delphi Panel published a report of recommendations for classifying dry eye disease. Dr. de Luise said that the International Dry Eye Workshop (DEWS) met in 2007 to propose guidelines for diagnostic and therapeutic management of dry eye. Under this, dry eye disease was stratified into four levels, depending on the severity of symptoms and signs. Dr. de Luise said that this four-tiered system may be some- what cumbersome for physicians to remember and implement. He sug- gested simplifying the levels to three tiers: mild, moderate, and severe. "Armed with a keen sense of what to look for in DED, and with the excellent recommendations of the DEWS panel, the eye physician is in an excellent position to make a positive impact on the visual qual- ity, comfort, and lives of patients," Dr. de Luise said. EW Editors' note: Drs. de Luise and Perry have no financial interests related to their comments. Contact information de Luise: eyemusic73@gmail.com Perry: hperry@ocli.net

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