Eyeworld

EW FEATURE 90 Challenging cataract cases • October 2017 start NSAIDs 3 days prior to surgery and will continue for 1–3 months even after uncomplicated surgery for diabetics. "Many peer-reviewed studies have shown that using NSAIDs perioperatively can be beneficial in decreasing the risk of developing and treating macular edema," Dr. Henderson said. "I prescribe top- ical NSAIDs for all diabetics for 3 months after cataract surgery." Multifocal IOLs in patients with diabetic retinopathy Dr. Boyer does not think that a multifocal lens is a good choice for these patients. An OCTA may aid in determining the status of the macu- la, he said. With multifocal IOLs, one loses about 20% of overall quality of vision, Dr. Stark said, and patients put up with that to see at distance and near. "But when you're dealing with a diseased eye, I don't think it's a good idea to put in a multifocal IOL," he said. Multifocal IOLs can decrease contrast sensitivity, Dr. Henderson said, so it is important to assess the eye carefully for other comorbid diseases. "If a patient has significant diabetic retinopathy, I usually do not recommend a multifocal IOL," she said. "If the amount of retinop- athy is mild, stable, and there is no macular disease, it is reasonable to discuss multifocal IOLs." The preoperative counseling is crucial to discuss the potential disadvantages and limitations of multifocal IOLs, Dr. Henderson added. Dr. Warren does not think a multifocal lens is an appropriate op- tion for a patient with diabetes and shouldn't be used at all if the patient has retinopathy. He said that 95% of patients who have diabetes more than 20 years will have some form of retinopathy. Multifocals reduce contrast, Dr. Warren said, so they are not a good option for a diabetic, and if the patient already has edema, this also reduces contrast. Postop CME in diabetic eyes If a patient develops CME, regardless of a history of diabetes, Dr. Hender- son obtains the advice of her retina colleague. "I will usually start with topical steroids and NSAIDs," she said. "If the edema persists, other options such as injections of steroids or anti-VEGF agents are considered depending on the patient." The rate of postop macular edema would be greater in these pa- tients, Dr. Stark said, adding that the ophthalmologist would want to cut down on inflammation as much as possible. Preop and postop NSAIDs can be used but that physicians should be careful if the patient has a persistent epithelial defect. Dr. Boyer usually starts with topical drops—steroid and non-ste- roidal—but moves to intravitreal steroid injections if no progress is seen when patients are treated. EW Editors' note: Drs. Boyer, Henderson, Stark, and Warren have no financial interests related to their comments. Contact information Boyer: vitdoc@aol.com Henderson: bahenderson@eyeboston.com Stark: wstark@jhmi.edu Warren: kwarren@warrenretina.com Warren said, they should consider a depot steroid injection prior to sur- gery, and they should be managed with OCT and be advised that the outcome may be guarded. The use of NSAIDs can be controversial, Dr. Henderson said. According to the ASCRS Clinical Survey, the majority of ophthalmol- ogists in the U.S. and worldwide use NSAIDs preop and postop for high risk patients, such as diabetics. Most (800) 367-8327 DuPont, WA 98327 info@lacrimedics.com • www.lacrimedics.com ©2017 Lacrimedics, Inc. 1 ASCRS Clinical Survey 2015. Global Trends in Ophthalmology and the American Society of Cataract and Refractive Surgery. Don't let 41% of your patients with OSD go untreated, especially when they need something more than artifi cial tears. Lacrimedics' VisiPlug® is FDA approved for the treatment of the Dry Eye components of varying Ocular Surface Diseases (OSD), after surgery to prevent complications due to Dry Eye Disease, and to enhance the effi cacy of topical medications. VisiPlug® – Provides approximately 180 days of occlusion so you can better manage your patients' treatment plans. Don't let 41% of your patients 41% of refractive or cataract surgery patients have ocular surface dysfunction levels requiring some treatment beyond artifi cial tears! 1 0.4mm 0.5mm Cataract continued from page 89

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