Eyeworld

EW FEATURE 78 Laser vision correction • February 2018 tear breakup time testing, topogra- phy, and meibography. The latter, she said, is one of the newer dry eye diagnostic tools that she thinks "can give us a lot of clues to the health of the ocular surface, and it gives the patient an image of their disease, if they do show such signs." Dr. Gupta said the most com- mon tests to screen for dry eye in her practice are osmolarity testing, MMP-9 (an inflammatory mark- er) testing, and meibomian gland imaging. "These tests give me a great understanding of how the ocular surface is functioning at the time of my evaluation," Dr. Gupta said. "Hyperosmolarity is a core mech- anism in dry eye disease and with prolonged hyperosmolarity inflam- mation is triggered; this is where the MMP-9 test is helpful as it identifies critical levels of inflammation on the ocular surface. Last but not least, MGD is a big part of DED. Often clinical exam is insufficient to allow us to see how advanced MGD is. On many occasions, I have examined a patient clinically and found mild to moderate MGD, only to find severe gland atrophy on MG imaging. Understanding the degree of gland atrophy helps to understand disease severity and allows the physician to set realistic expectations with the patient." Dr. Gupta will perform tear osmolarity testing and meibography on all patients. If either of those tests are positive for disease she will advance to MMP-9, Sjögren's syn- drome, and/or allergy testing. Most patients, after their dry eye is managed, can go on to have successful refractive surgery, Dr. Loh said. While there has been increased awareness efforts on the importance of treating the ocular surface prior to refractive surgery, including for refractive cataract surgery, Dr. Loh said taking the time to really treat these patients can be a hurdle. EW References 1. Zhao J, et al. Effect of higher-order aber- rations and intraocular scatter on contrast sensitivity measured with a single instrument. Biomed Opt Express. 2017;8:2138–2147. 2. Sarkar S, et al. Image quality analysis of eyes undergoing LASER refractive surgery. PLoS One. 2016;11:e0148085. 3. Ambrósio R Jr, et al. Integration of Scheimpflug-based corneal tomogra- phy and biomechanical assessments for enhancing ectasia detection. J Refract Surg. 2017;33:434–443. 4. Haddad J, et al. First clinical impressions on the integrated corneal tomography and corne- al deformation with Scheimpflug imaging. Int J Kerat Ect Cor Dis. 2017;6:101–109. 5. Silverman RH, et al. Epithelial remodeling as basis for machine-based identification of keratoconus. Invest Ophthalmol Vis Sci. 2014;55:1580–7. 6. Reinstein DZ, et al. Comparison of corneal epithelial thickness measurement between Fourier-domain OCT and very high-fre- quency digital ultrasound. J Refract Surg. 2015;31:438–45. 7. Urs R, et al. Comparison of very-high-fre- quency ultrasound and spectral-domain optical coherence tomography corneal and epithelial thickness maps. J Cataract Refract Surg. 2016;42:95–101. Editors' note: Dr. Gupta has finan- cial interests with Johnson & John- son Vision (Santa Ana, California), TearLab (San Diego), and TearScience (Morrisville, North Carolina). Dr. Loh has financial interests with Allergan (Dublin, Ireland) and Shire (Lexington, Massachusetts). Dr. Reinstein and Dr. Rocha have no financial interests relat- ed to their comments. Contact information Gupta: preeyakgupta@gmail.com Loh: jenniferlohmd@gmail.com Reinstein: dzr@londonvisionclinic.com Rocha: karolinnemaia@gmail.com Advances continued from page 77 APRIL 12, 2018 WASHINGTON, DC 999 Ninth Street NW Washington District Of Columbia 20001 CELEBRATING 10 YEARS OF INNOVATION UNITING OVER 500 LEADERS IN THE DEVELOPMENT OF GROUND-BREAKING OPHTHALMIC TECHNOLOGIES WWW.OIS.NET /OIS.NET @OISTWEETS /OPHTALMOLOGYSUMMIT RENAISSANCE WASHINGTON, DC DOWNTOWN

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