Eyeworld

4 The impact of ocular surface dysfunction on surgical outcomes: Evidence-based insights on diagnostic tools to guide treatments by Alice Epitropoulos, MD, FACS Ocular surface testing insights: Meibomian gland imaging Meibomian gland imaging enables early detection of meibomian gland disease and intervention T he prevalence of mei- bomian gland disease (MGD) has been reported to be as high as 60 to 70%. 1,2 It is increasingly becoming recognized as a chronic progressive disease and the lead- ing cause of dry eye disease (DED), which can adversely affect our re- fractive cataract surgery outcomes if it is not treated. Furthermore, DED is the leading reason why people stop wearing contact lenses. Unfortunately, because signs often are not always obvious on examination, MGD is extremely underdiagnosed. If we can diagnose MGD early and intervene before severe damage occurs, treatment will be more effective and our patients will be more satisfied with their outcomes. Detection of MGD Meibography allows clinicians to examine the meibomian glands. Recently, LipiView II, a system with high-definition imaging, was introduced, enabling clinicians to assess the lipid layer and detect structural compromise of the mei- bomian glands, indicating MGD (Figure 1). Because symptoms may not correlate with the degree of disease when MGD is in its early stages, meibomian gland imaging should be strongly considered. Furthermore, the degree of structural compromise found can impact the urgency of therapeutic intervention. Research has shown that if more than 67% of the gland Alice Epitropoulos, MD, FACS continued on page 6 Figure 1. Meibomian gland images showing none to mild, moderate, and severe meibomian gland dysfunction. Source: TearScience IgE, confocal microscopy of meibo- mian glands, and others. This basket of test data, in addition to clinical judgment and a careful exam, can save the clinician in the modern practice significant chair time. Although we include every available test in the algorithm, we are not recommend- ing that every practice use every test. The algorithm will help prac- titioners utilize whichever tests they have available. Systematic process This algorithm sheds light on the vast new world of ocular surface disorders, which has been some- what elusive to the general prac- titioner in recent years. The novel ASCRS algorithm will be a practi- cal tool to enable ophthalmolo- gists to work more efficiently, save chair time, and make the correct OSD diagnosis more often. Dr. Starr is associate professor of ophthalmology, director of the refractive surgery service, and director of the cornea, cataract, and refractive surgery fellowship, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York. Making the most of physician extenders W ith the new diagnostics we have at our disposal, much of the workup is driven by physician extenders, and the new algorithm reflects that. However, clinicians can perform as much of the initial workup as they would like. I find it very useful to have a basket of objective, noninvasive ocular surface data at my fingertips before I see the patient, so I know exactly what I am dealing with from the beginning. continued from page 3

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