Supported by unrestricted educational grants
from Shire, TearLab, and TearScience
he would have been very
unhappy.
With this case, the
surgeon should realize
the importance of point-
of-care testing preopera-
tively, such as topography
and biometry. This case
stresses that ocular sur-
face disease and dry eye
may have a significant
impact on preoperative
readings, such as topog-
raphy and biometry, and
ultimately the surgeon's
choice of optical correc-
tion (Figures 5 and 6).
References
1. Atchison DA, et al. Optics of
the Human Eye. Edinburgh, U.K.
Butterworth-Heinemann; 2000.
2. Trattler WB, et al. The Pro-
spective Health Assessment of
Cataract Patients' Ocular Sur-
face (PHACO) study: the effect
of dry eye. Clin Ophthalmol.
2017;11:1423–1430.
Contact information
Al-Mohtaseb:
zaina1225@gmail.com
Gupta: preeya.gupta@duke.edu
Kim: terry.kim@duke.edu
Mah:
Mah.Francis@scrippshealth.org
Figures 5 and 6: 2 D shift in IOL power given change in K values and significant decrease in astigmatism; placed
a presbyopic lens and the patient was very happy postoperatively; the images demonstrate more irregular
astigmatism with a steeper keratometry and more astigmatism, while the topography treatment shows more
regular topo, with flatter keratometric values and less astigmatism; aggressive treatment of OSD before cataract
surgery prevented a hyperopic outcome
Source: William Trattler, MD
The topography read-
ings showed significant
astigmatism. Topography
evaluation is important
preoperatively not only
for looking at the magni-
tude of astigmatism but
also the quality of it.
Is it regular?
This specific patient
was treated for 1 month
with topical steroids and
lifitegrast. Post-treatment
topography showed a
significant change in the
topography values. There
was a flattening of the Ks,
a decrease in astigmatism
(1.55 to 0.34), and a 2
D shift in IOL power. If
the patient had received
a toric presbyopic lens
7
