Eyeworld

Reporting from the Combined Ophthalmic Symposium (COS), August 11–13, Austin, Texas EW MEETING REPORTER 120 September 2017 Khandelwal has financial interests with Allergan. Ocular surface disease (OSD) The ocular surface is a key compo- nent for surgical success, said Elizabeth Yeu, MD, Norfolk, Vir- ginia, adding that the majority of cataract patients have ocular surface disease (OSD). Ocular surface disease reduces the accuracy of preoperative refrac- tive measurement and pre- and post- operative visual quality and visual acuity, she said. Any ocular surgery will worsen OSD, Dr. Yeu said. Meibomian gland disease/blepharitis may increase the risk of endophthal- mitis or TASS. Dr. Yeu and Nicole Fram, MD, Los Angeles, shared some of the treatment options available to ad- dress the problem of ocular surface disease. Dr. Fram shared several case presentations, two in particular where she used superficial keratec- tomy with diamond burr. She then shared a case of a 41-year-old female with contact lens intolerance whose BCVA with glasses had dropped by three lines. Dr. Fram stopped contact lens wear and replaced all topical drops with preservative-free formu- lations (she noted that preservatives stress the stem cells). She used cyc- nisms of action, and she has used both together for some patients and has seen improvement. Some people prefer one to the other, she said, noting that a study comparing the two medications would be helpful. The key is having started patients on topical steroids to make sure they can get through the initial burning and irritation, she added. Sumitra Khandelwal, MD, Houston, weighed in, saying that Xiidra is the newer drug, but she won't switch over anyone who is already doing well with Restasis. She added the insurance and reimburse- ment factors also come into play. Jonathan Solomon, MD, Bowie, Maryland, said he would be cautious about having a patient on both medications, especially if there is potential for them to have anoth- er autoimmune disorder. He noted that he has seen issues with people having unique changes to the cor- nea when starting on both. Dr. Khandelwal said that the new TrueTear neurostimulator device (Allergan) could be helpful to dry eye patients and could help fill the gap between Restasis/Xiidra and other treatments. Editors' note: Drs. Al-Mohtaseb and Solomon have no financial interests related to their presentations. Dr. to the thinnest point. The changes need to be consistent over time and above the normal variability of the measurement system. He noted that although progression is often ac- companied by a decrease in BSCVA, a change in both uncorrected visual acuity and BSCVA is not required to document progression. Preoperative patient education is very important in these cases, Dr. Garg said, adding that you should set the expectation that crosslink- ing is not refractive surgery. He also said to educate patients regarding the time course of the postoperative healing process. On average, Dr. Garg said, steepening of Kmax is observed at 1 month postoperative- ly, followed by flattening through 12 months. He also said that 1–2% of patients may have a corneal epithelium defect, corneal edema, corneal opacity, or corneal scar at 12 months. Dr. Garg went on to discuss the specifics of the procedure and de- tailed how to handle patients post- operatively. After the procedure, it's important to use a bandage contact lens, antibiotic eye drops, anti-in- flammatory eye drops, lubricant eye drops, and pain medications. Expect initial steepening, as well as initial worsening of vision and then improvement. Ideal candidates are young, healthy progressive keratoconus patients; are able to lay still for more than an hour; have adequate corneal thickness; have a clear visual axis; and have good vision in contact lenses or glasses. Older patients, those with stable keratometry and refractions, those with very steep or very thin corneas, and those with central corneal scarring are not ideal candidates. Editors' note: Dr. Garg has no financial interests related to his presentation. Dry eye panel A panel discussion on dry eye led to the question of choosing between Restasis (cyclosporine, Allergan) and Xiidra (lifitegrast, Shire, Lexington, Massachusetts). Zaina Al-Mohtaseb, MD, Houston, said that the medi- cations have two different mecha- View videos from COS 2017: EWrePlay.org Douglas Koch, MD, discusses strategies for success when using presbyopia-correcting IOLs.

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