Eyeworld

may still want to evaluate for dry eye disease. Visual quality testing has a more important role in preop- erative patients and is less emphasized in DEWS II. It is an aggressive ap- proach to try to normal- ize those patients who are going through surgery. We don't have the luxury to treat for 6 months to a year, so you may use multiple entities to try to treat these patients and normalize the ocular surface prior to refractive or cataract surgery. DED is ruled in, identi- fy the primary sub-type (Figure 2). The ultimate aim of DED management is to restore homeostasis. In the DEWS II report, they try to emphasize the fact that you can't pick one thing then a second thing right after. There are many components to the management of the different stages of dry eye disease, and it's a discus- sion between the patient and the clinician. Finally, with the ASCRS Cornea Clini- cal Committee: Preop Cataract and Refractive Surgery Algorithm, the focus is more on surgical patients, including how to evaluate those patients coming in for surgery and how to prepare them for surgery. One of the key factors to highlight from the PHACO study 2 is that prospectively studying patients coming into the office for cataract surgery, 77% had abnormal corne- al staining, yet only 13% reported significant symp- features 150 worldwide experts from 23 differ- ent countries and was published in 2017. The medical literature within the report has doubled in size with regard to dry eye disease, and this is a huge review in terms of dry eye and ocular surface disease. Similar to the DEWS I report, DEWS II describes the definition of dry eye as either aqueous deficient dry eye or evap- orative dry eye. In the DEWS II report, a large component of the algo- rithm represents mixed dry eyes. The TFOS DEWS II stresses that hyperos- molarity is at the core of DED and is primarily driven by evaporation. The loss of homeostasis by various entry points can lead to a chain of events that leads to in- flammation of the ocular surface. There is also an inter- esting diagnostic meth- odology of TFOS DEWS II, which features three steps: triaging questions; diagnosis of DED; and if " Dry eye can cause fluctuation in vision because of the role of the tear film, which is the most important refractive system in the eye. " —Francis Mah, MD 4 Customizing modern OSD therapies to individual patient needs toms of ocular surface disease. So these patients are unaware of their ocu- lar surface disease, and to provide the best possible refractive outcome and prevent complaints after surgery, you want to opti- mize the patients' ocular surface prior to surgery (Figure 3). We're a little more ag- gressive in the treatment and trying to expedite the normalization of the ocular surface in the ASCRS algorithm. We do have the entry point of a survey question. But even if the patient does not have symptoms, you

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