Eyeworld

EW FEATURE 86 World Cornea Congress highlights September 2015 by EyeWorld staff potential benefits in guiding treat- ment," she said. The new test that she is most enthusiastic about is the LipiView II. "The ability to image and see mei- bomian gland disease at the root is very exciting. This should get more patients [to understand] the serious- ness and chronic nature of their dry eye disease," she said. ASCRS members were also asked the following question: Overall, when do you believe advanced tear film diagnostics (such as osmolarity and interferometry) should be incor- porated into your practice flow? Almost 40% of U.S. respondents don't see any value in incorporating advanced tear film diagnostics into their practice flow, 5.8% higher than non-U.S. respondents (33.6%). The difference in responses between U.S. and non-U.S. doctors was not statis- tically significant (Figure 2). According to Dr. Farid, ad- vanced tear film diagnostics should be incorporated into practice at the initial visit, which is when she typically uses them. "There is no reason to wait to appropriately diagnose these patients and catego- rize their dry eye severity. The rest of the treatment protocol should then be derived from the results of these tests," she said. EW Editors note: Dr. Farid has financial interests with TearScience. Contact information Farid: mfarid@uci.edu Tests to diagnose ocular surface disease ASCRS members weigh in B ecause ocular surface dis- eases can negatively affect the outcome of cataract and refractive surgical pro- cedures, it is important for these diseases to be diagnosed and treated preoperatively. In the 2014 ASCRS Clinical Survey, ASCRS members were sur- veyed about the tests often used to aid in the diagnosis of ocular surface disease. When asked how much they believe that certain tests can reliably increase the diagnostic accuracy of ocular surface diseases and treat- ment efficacy, with the exception of corneal and conjunctival staining, non-U.S. respondents strongly agree or agree at higher rates than U.S. re- spondents that the tests can reliably increase their diagnostic accuracy of ocular surface diseases and treat- ment efficacy, ranging from 5.7% to 22.8% higher than U.S. respondents. Statistically significant differences between U.S. and non-U.S. respon- dents are highlighted in green in Figure 1. Many surgeons are using multi- ple tests to get as much information as possible. "I use all the available tools to help me in diagnosing the type of dry eye disease I am dealing with, and then I tailor my treat- ments accordingly," said Marjan Farid, MD, University of California, Irvine. "With increasing awareness of inflammation as an underlying culprit for chronic dry eye disease, the InflammaDry test [Rapid Patho- gen Screening, Sarasota, Fla.] has be- come an integral part of my practice. Additionally, I use osmolarity testing to monitor my treatment response. The LipiView II [TearScience, Morris- ville, N.C.] has become a very useful tool for me as well. It allows patients to witness the degree of their lid margin disease and become more active participants in their treatment regimen." Dr. Farid noted that the survey data show that advanced diagnostics are slowly becoming more recog- nized as essential tools in the man- agement of dry eye disease. "I am still surprised by the high percentage of doctors who don't see any value in their use. I think this may be directly related to overall lack of education out there regarding their Global Trends in Ophthalmology ™ Copyright © 2015 Global Trends in Ophthalmology and the American Society of Cataract & Refractive Surgery. All rights reserved. Figure 2 Source: ASCRS 60.0% At the initial point of care in most patients On a case by case situation as decided during the consultation I don't see any value in incorporating these into my practice U.S. Non-U.S. Overall Test U.S. Non-U.S. Overall Schirmer's test Strongly agree or Agree 51.1% 73.9% 62.0% Corneal and conjunctival staining Strongly agree or Agree 92.7% 88.7% 90.9% Tear breakup time Strongly agree 24.8% 35.1% 29.4% Osmolarity Strong agree or Agree 46.8% 52.5% 49.7% Lipid layer interferometry Strongly agree or Agree 22.6% 37.5% 29.9% MMP-9 markers Strong agree or Agree 21.2% 31.4% 25.7% Blood work for systemic inflammatory conditions (i.e., Sjögren's syndrome, thyroid disease) Strong agree or Agree 49.6% 55.7% 52.2% Figure 1 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0%

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