Eyeworld

2 The impact of ocular surface dysfunction on surgical outcomes: Evidence-based insights on diagnostic tools to guide treatments cians' diagnostic skills but to pro- vide important supplemental data to help us accurately diagnose the patient. For example, we may not find corneal fluorescein staining or an abnormal tear breakup time during our slit lamp examination, but patients may have positive results on osmolarity or MMP-9 testing that indicate early and even asymptomatic disease. Conclusion In this supplement, our expert faculty will discuss a new algo- rithm for DED diagnosis and treatment and share their advice for integrating osmolarity, MMP-9 Furthermore, Donnenfeld et al. reported differences between patients treated with ocular lubri- cants before LASIK compared with those who were only treated after LASIK.4 Patients were more likely to have worse visual outcomes if they had tear hyperosmolar- ity and were not treated before LASIK. To obtain optimum results, it is essential to manage the ocular surface before performing preop- erative measurements for cataract or refractive surgery, particularly when implanting toric, multifo- cal, and accommodating intraocu- lar lenses. Figure 2 shows member responses from the 2015 ASCRS Clinical Survey regarding cataract and refractive surgery. Although patients may be disappointed when surgery is de- layed, if surgeons do not address the ocular surface before preoper- ative measurements are made, it could adversely affect the patient's visual outcome and cause the pa- tient to shift the blame from the disease state to the surgeon. Diagnosing DED Although patients with DED may have burning, tearing, or other types of irritation, others are asymptomatic. Furthermore, patients may have anterior basement membrane disease, Salzmann's nodular degeneration, or other ocular surface conditions that may adversely affect out- comes as well. DED increases with age and is more common in women. In ad- dition, patients may use medica- tions that affect the tear film. For example, glaucoma medications may cause an abnormal ocular surface due to corneal toxicity. Surgery also can induce DED. Yu et al. reported that both fem- tosecond laser and conventional cataract surgery increased dry eye after surgery.5 New point-of-care tests can help identify DED or OSD signs so we can identify cases early and treat them proactively. These tests are not designed to replace clini- continued from page 1 Figure 1. In the 2015 ASCRS Clinical Survey, respondents answered the following question: On average, how many dry eye patients do you see per month who are on a prescription medication for dry eye therapy or have had punctal occlusion (i.e., need more than just tears)? None 1–5 6–10 11–25 26–50 51–99 100 or more 30% 25% 20% 15% 10% 5% 0% Average Pct All 31 U.S. 32 Non U.S. 30 All U.S. Non U.S. Figure 2. In the 2015 ASCRS Clinical Survey, only 39% of respondents strongly agreed that mild to moderate dry eye significantly impacts satisfaction in postoperative cataract and refractive surgery patients. 60% 50% 40% 30% 20% 10% 0% Strongly Agree Agree Undecided Disagree Strongly Disagree All U.S. Non U.S. testing, and meibomian gland imaging into their practices. References 1. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5:75–92. 2. 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. 3. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–1677. 4. Donnenfeld ED, et al. Measurement of refractive surgery induced dry eye using tear osmolarity testing. ESCRS, Vienna, Austria, 2011. 5. Yu Y, et al. Evaluation of dry eye after femtosecond laser-assisted cata- ract surgery. J Cataract Refract Surg. 2015;41:2614–2623. Dr. Kim is professor of ophthal- mology, Duke University School of Medicine, and chief of the cornea and external disease division, and director of the refractive surgery service, Duke University Eye Center, Durham, North Carolina.

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