Eyeworld

Advanced diagnostics in action: Identifying ocular surface disease in cataract and refractive patients Supported by unrestricted educational grants from Allergan, Shire, TearLab, and TearScience Accreditation Statement This activity has been planned and implemented in accordance with the accreditation require- ments and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • List cataract preoperative screening tests impacted by ocular surface disease • Assess current and emerging OSD diagnostic tools • Differentiate between the various therapeutic classes and treatments Designation Statement The American Society of Cataract and Refractive Surgery designates this enduring materials educational activity for a maximum of 1.0 AMA PRA Category 1 Credits. ™ Physicians should claim only credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants must visit bit.ly/2pyQ2Id to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indi- cated for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard in- ternet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through December 31, 2017. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ ascrs.org or 703-591-2220. Financial Interest Disclosures Eric Donnenfeld, MD, has an investment interest in and has received a retainer, ad hoc fees, or other consulting income from: AcuFocus, AqueSys, Elenza, Glaukos, Icon Biosciences, Kala Pharmaceuticals, Katena, Mimetogen, NovaBay, Omeros, PRN, and TearLab. He has an investment interest in: LacriScience, Mati, Omega Ophthalmics, Ocuhub, Pogotec, RPS, Strathspey Crown, TrueVision, and Versant Ventures. Dr. Donnenfeld has received a retainer, ad hoc fees, or other consulting income from: Abbott, Alcon, Allergan, Bausch + Lomb, Bea- ver-Visitec, Foresight, Novaliq, Shire, and TLC Laser Centers. He is a member of the speakers bureaus of: Pfizer, RPS, and TLC Laser Centers, and he has received research funding from: Alcon, Allergan, Bausch + Lomb, Beaver-Visitec, Icon Biosciences, Kala, Omeros, PRN, and Shire. Alice Epitropoulos, MD, has an investment interest in NovaBay. She has received a retainer, ad hoc fees, or other consulting income from PRN. She is a member of the speakers bureaus of: Allergan, Bausch + Lomb, BioTissue, NovaBay, Omeros, RPS, Shire, TearLab, and TearScience. Dr. Epitropoulos has received research funding from: Bausch + Lomb, PRN, TearLab, and TearScience, and has received travel expense reimbursement from: Allergan, Bausch + Lomb, and Shire. John Hovanesian, MD, has an investment interest in, has received a retainer, ad hoc fees, or other consulting income, is a member of the speakers bureaus of, has received research funding and travel expense reimbursement from: Abbott, BlephEx, Guardian Health Sciences, Ocular Therapeutix, and Sight Sciences. He has received a retainer, ad hoc fees, or other consulting income, is a member of the speakers bureaus of, has received research funding and travel expense reimbursement from: Aerie, Alcon, Bausch + Lomb, Katena, Omeros, Shire, and TearScience. Dr. Hovanesian has an invest- ment interest in: Alicia Surgical Center, Allegro Ophthalmics, Allergan, Ivantis, MDbackline, Sarentis Ophthalmics, and TLC Laser Centers, and receives royalty or derives other financial gain from MDbackline and Slack Books. He has received a retainer, ad hoc fees, or other consulting income from and is a member of the speakers bureaus of: AcuFocus, Allergan, and Ivantis. He has received consulting income from: 800Doctors, Sarentis Ophthalmics, and Videco Medical Education, is a member of the speakers bureau of Revision Optics, and has received travel expense reimbursement from Ivantis. Cynthia Matossian, MD, has an investment interest in: PRN, Progressive Tech Training, RPS, and Strathspey Crown. She is a member of the speakers bureaus of: Abbott Medical Optics, Al- con, Allergan, Bausch + Lomb, Bruder, Checked Up, Imprimis, i-Optics, Lenstec, MARCO, Ocular Therapeutix, Omeros, Shire, Sun Pharmaceuti- cals, and TearLab. Staff members: Kristen Covington and Laura Johnson have no ophthalmic-related financial interests. Supplement to EyeWorld June 2017 continued on page 2 by dry eye. 2 We are moving to- ward routinely administering this questionnaire to patients with cataracts and performing objec- tive diagnostic testing in those with positive scores. We also test asymptomatic patients with signs of dry eye on examination. Establishing protocols A detailed dry eye questionnaire is a good first step in understand- ing a patient's symptoms. I use the SPEED questionnaire: It's sim- ple, questions are straightforward, and it is fairly sensitive to visual disruption and symptoms caused N early 80% of cataract- age patients have dry eye disease—a major contributor to inaccu- rate visual outcomes after refractive surgery. 1 Whether a patient is having LASIK or re- fractive cataract surgery, postop- erative uncorrected visual acuity correlates strongly with patient satisfaction. However, patients in their 70s or 80s with advanced dry eye may be asymptomatic because the dry cornea becomes desen- sitized over time. Consequently, ophthalmologists are less likely to treat conditions that do not cause complaints unless they threaten the patient's vision. However, this is a mistake because even in borderline cases with few signs or symptoms, surgery may tip the scales, triggering symptoms and affecting refractive outcomes. Whether patients seek laser vision correction or refractive cataract surgery, untreated dry eye can diminish visual outcomes by John Hovanesian, MD Implementing advanced diagnostic protocols to identify ocular surface disease and enhance refractive outcomes John Hovanesian, MD " When implementing new protocols, we cannot spend enough time educating and training staff. " –John Hovanesian, MD Click to read and claim CME credit

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