Eyeworld

6 Navigating OSD treatments, technologies, and techniques for today's refractive cataract practice proceed with treatment if they understand the disease and the reason for delay in surgery. Point-of-care testing helps illustrate this point. For example, we show patients dynamic meibo- mian gland imaging and correlate that with the function of their oil glands. It is particularly important to optimize the tear film before implanting premium intraocular lenses (IOLs). If a patient's tear film has not been optimized, I will not implant a multifocal IOL. Higher-order aberrations of the tear film can cause significant vi- sual disturbances in patients with a multifocal IOL. Tailored treatment Our test results help us develop a treatment plan. Patients require an individualized cocktail of treatments to effectively nor- malize their tear film. We do not prescribe everything at once but work up their treatment. Most patients have an evap- orative component to their OSD, so all patients are treated with warm compresses and lid margin therapies. For many patients with meibomian gland dysfunction, I prescribe the thermal pulsation system to kick-start the function and quality of their meibum. If we identify inflammatory cytokines by positive MMP-9 test- ing, I prescribe an anti-inflamma- tory agent, such as a short course of steroids like loteprednol with a longer-acting cyclosporine. Omega-3 fatty acids have been shown to significantly im- prove lipid layers. The American diet lacks the essential omega-3 fatty acids needed for their anti- inflammatory properties. I prescribe oral doxycycline in patients with staphylococcal marginal keratitis or significant inflammation, thick lids, and red- ness. The dual action of anti-in- flammatory and antimicrobial effects can have a significant ther- apeutic effect in some patients. Conclusion To achieve the best outcomes in refractive cataract surgery, clini- cians need to aggressively search for OSD using point-of-care diagnostics and treat this disorder before surgery. Reference 1. Trattler WB, et al. Cataract and dry eye: Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) Study. San Diego: ASCRS•ASOA Symposium & Congress, March 2011. Dr. Farid is associate professor of ophthalmology, director of cornea, cataract, and refractive surgery, and vice chair of ophthalmic faculty, Gavin Herbert Eye Institute, University of California, Irvine. continued from page 5 " Patients require an individualized cocktail of treatments to effectively normalize their tear film. " –Marjan Farid, MD Figure 3. Respondents to the 2015 ASCRS Clinical Survey reported their primary therapies in treating severe dry eye. Primary therapy: severe DED (Aqueous deficient or unspecified) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Any artificial tear/lubricant Customized artificial tear/ lubricant Cyclosporine Omega-3 Thermal lid expression Punctal occlusion Topical ste- roid Azithromycin 45% 28% 53% 50% 74% 72% 49% 42% 20% 21% 77% 79% 68% 54% 27% 20% U.S. Non U.S. Figure 4. Survey respondents reported their primary therapies in treating MGD. Primary therapy: MGD 70% 60% 50% 40% 30% 20% 10% 0 Any artificial tear/lubricant Customized artificial tear/ lubricant Cyclosporine Omega-3 Thermal lid expression Punctal occlusion Topical ste- roid Azithromycin 38% 31% 39% 40% 22% 18% 59% 48% 45% 64% 9% 4% 38% 36% 64% 62% U.S. Non U.S.

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