Eyeworld

10 World view Optimize surgical plans for better patient outcomes C ataract surgery remains one of the most successful surgeries performed in ophthalmology with the potential to change patients' lives in amazing ways. However, increasing demand for precise refractive outcomes requires that the ophthal- mologist optimize many aspects of the pre-op- erative planning stages for the patient. Many variables can affect final target visual outcomes, especially as the tear film and cornea are the primary refracting surfaces of the ocular system. No matter if you practice in a low or high volume refractive cataract surgery practice, being aware of your patient's ocular surface, knowing how to treat and optimize the tear film, and being aware of options available to deal with irregular corneal astigmatism, is crucial to achieving accurate intraocular lens calculations and happy patient outcomes. In this issue, leading experts Simon Holland, MD, and Raymond Stein, MD, explain their preferred approach to dealing with keratoconus patients needing cataract surgery, how topography-guided PRK can be used in pa- tients with irregular astigmatism, and when Intacs (AJL Ophthalmic, Miña- no, Spain) intrastromal corneal segments may be useful. Sumit "Sam" Garg, MD, Lawrence Hirst, MD, and Christopher Rapua- no, MD, present the best ways to diagnose and treat ocular surface lumps and bumps including Salzmann's nodules, epithelial basement membrane dystrophy, and pterygia. These pathologies are important in the context of intraocular calculations and the timing of when to best perform these mea- surements are also discussed. Commercial preparations of amniotic membrane are available with a wide variety of options with respect to thinner and thicker tissue; cryopre- served or freeze dried; and placement stromal side up or down. Neel Desai, MD, Kendall Donaldson, MD, and Preeya Gupta, MD, comment on their experiences in offering amniotic membrane to patients prior to cataract surgery to optimize the ocular surface and subsequent timing of intraocular calculations and surgery. A large multi-centered study termed "the PHACO study" found that almost two-thirds of patients had clinical signs of dry eye prior to cataract surgery. It is important not to neglect diagnosing dry eye and to educate your patients on the importance of treatment and the chronic nature of the disease process. Otherwise, your patient might return to you in follow up after cataract surgery complaining of dry eye symptoms and being unhappy with the quality of their vision. They will likely focus not on their new 20/20 vision, but rather their ocular discomfort and fluctuating vision. Vincent de Luise, MD, Edward Holland, MD, John Hovanesian, MD, Bill Trattler, MD, and Elizabeth Yeu, MD, discuss how to best diagnose patients with dry eye, how to explain the importance and implications of the diagnosis to patients, treatment options, and timing for scheduling cataract surgery. I hope you enjoy this issue of EyeWorld and thank you to all the phy- sicians above for taking the time to share their expertise on the topic of treating the cornea prior to cataract surgery. EW Clara Chan, MD, Cornea editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S May 2017 Volume 22 • No. 5 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org Jaclyn Talon jaclyn@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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