Eyeworld

degrees or more is acceptable (Figure 2). However, we know we will see a significant decrease in quality of vision when we see rotation of 10 degrees or more. When clinicians were asked, "What level of inflammation 3–7 days after cataract surgery do you believe has a clinically significant impact on visual acuity/quality of visual recovery and/or patient comfort and satisfaction?" almost half believe that 1+ cell/flare has a clinically significant impact on visu- al acuity, quality of visual recovery, and/or patient comfort and satisfac- tion (Figure 3). This demonstrates that there is increased awareness of the significance of inflammation and the role it plays in outcomes regarding vision and pain. Thirty percent expect normal cell and flare levels of 1+ or greater 3–7 days after surgery (Figure 4). Forty-seven percent of respon- dents are not preloading anti-in- flammatories (NSAIDs or steroids) in cataract patients. Forty percent of respondents are using both steroids and NSAIDs one day after surgery. Expert recommendations Based on their experiences and expertise, our panel will share their recommendations regarding ways to optimize the ocular surface, reduce residual error, and reduce postopera- tive inflammation to deliver the best possible outcomes for your refractive surgery patients. Reference 1. ASCRS Clinical Survey 2014. Global Trends in Ophthalmology. Fairfax, VA: American Soci- ety of Cataract & Refractive Surgery, 2014. Dr. Holland is director of the cornea service, Cincinnati Eye Institute, and professor of clinical ophthalmology at the University of Cincinnati, Ohio. He can be contacted at eholland@ holprovision.com. Figure 1. Most respondents to the 2014 ASCRS Clinical Survey did not know or use evidence-based guidelines to treat dry eye and meibomian gland dysfunction. Figure 2. Although nearly a third of respondents believe 10 degrees or more rotational error is acceptable after implantation of a toric IOL, quality of vision will decrease significantly when rotation is 10 degrees or more. Figure 3. Almost half of respondents believe 1+ cell/flare has a clinically significant impact on visual acuity, quality of visual recovery, and/or patient comfort and satisfaction, showing increased awareness of the impact of inflammation on visual outcomes and pain. Figure 4. Thirty percent of respondents expect some degree of inflammation 3–7 days after cataract surgery. However, the question remains whether surgeons can reach a new point with newer medications to reduce inflammation and potentially reduce postoperative pain. 45% of U.S. surgeons believe 1+ cell/flare has a clinically significant impact on visual acuity/quality of visual recovery and/or patient comfort and satisfaction U.S. Non-U.S. Overall 0.5+ cell/flare 1+ cell/flare 2+ cell/flare 3+ cell/flare 50 45 40 35 30 25 20 15 10 5 0 % of respondents Expectation of normal inflammation 3–7 days postop U.S. Non-U.S. Are we progressing toward the elimination of postop inflammation after cataract surgery? 0-trace cell/flare 1+ cell/flare % of respondents 80 70 60 50 40 30 20 10 0 30% of U.S. surgeons expect normal cell and flare levels of 1+ or greater 3–7 days postop [CATEGORY NAME], [PERCENTAGE] No, I use my own treatment protocols I don't know the guidelines Probably but not sure Yes, I adhere closely to them Most people don't know and/or don't use evidence-based guidelines 21.5% 29.6% 14.4% 34.5% 30% of respondents believe 10 degrees or more of error is acceptable Acceptable rotational error 10 degrees It depends 6–9 degrees 5 degrees Greater than 10 24% 6% 2% 15% 42% 9% Less than 5 degrees 53 Supported by unrestricted educational grants from Alcon Laboratories and Omeros

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