Eyeworld

4 Advanced diagnostics in action: Identifying ocular surface disease in cataract and refractive patients by Eric Donnenfeld, MD Case report: Sensitive diagnostic protocols mm in her left eye. She had 1+ lissamine green staining of the interpalpebral bulbar conjunctiva in both eyes and trace superficial punctate keratitis with fluorescein on her cornea. Point-of-service testing revealed tear film hyperosmo- larity in both eyes (301 OD and 317 mOsm). Research has shown that patients with tear hyperos- molarity before LASIK have worse outcomes after LASIK. 1 MMP-9 testing was also positive OU. 2 Most notably, her corneal to- pography demonstrated irregular mires with dropout (Figure 1). 3 Her uncorrected vision was counting fingers in both eyes and she was –5.0 D, –0.75 D at 150 degrees in the right eye and –4.75 D, –1.0 D at 15 degrees in the left eye. Her best corrected vision was 20/20- OU. She reported that her vision fluctuated between blinks and at the computer. On external disease evalu- ation, her lids revealed 2+ mei- bomian gland dysfunction with inspissated glands. Tear breakup time was 4 seconds in the right eye and 5 seconds in the left eye. Schirmer's scores with anesthesia were 18 mm in her right and 17 Precise diagnostics help detect ocular surface disease and guide treatment before surgery U ntreated ocular surface disease (OSD) can significantly impact visual outcomes after laser vision correction, dramatically deflating patients' high expectations. By developing a detailed diagnostic protocol for these patients, surgeons can iden- tify specific causes of dry eye and customize strategies to optimize the ocular surface before LASIK to enhance postoperative results. Case report After 15 years of contact lens wear, a 34-year-old woman be- came contact lens intolerant. She requested LASIK to improve her uncorrected vision and reduce her dependence on glasses. aggressively. The stepwise treat- ment algorithm helped stabi- lize his ocular surface for more reliable measurements to obtain optimal refractive results with his cataract surgery. References 1. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–1677. 2. Sambursky R. Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye. Clin Ophthalmol. 2016;10:2337–2343. 3. Arita R. Validity of noninvasive meibog- raphy systems: noncontact meibography equipped with a slit-lamp and a mobile pen-shaped meibograph. Cornea. 2013;32 Suppl 1:S65–70. 4. Epitropoulos AT, et al. Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes. Cornea. 2016;35:1185–1191. 5. Blackie CA, et al. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye. Clin Ophthalmol. 2016;10:1385–1396. 6. Stonecipher KG, et al. The IMPACT study: a prospective evaluation of the effects of cyclosporine ophthalmic emulsion 0.05% on ocular surface staining and visual performance in patients with dry eye. Clin Ophthalmol. 2016;10:887–895. Dr. Matossian is founder and medi- cal director of Matossian Eye Associ- ates, a multispecialty ophthalmology practice with multiple locations in Pennsylvania and New Jersey. She can be contacted at cmatossian@ matossianeye.com. " Meibography images showed significant gland dropout, helping the patient understand that he required lifelong treatment. " –Cynthia Matossian, MD Eric Donnenfeld, MD continued from page 3 " Irregular mires on corneal topography are a key sign of dry eye disease. " –Eric Donnenfeld, MD

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