Eyeworld

19 EW NEWS & OPINION June 2018 psoriasis presenting with ocular surface disease onto topical drops, such as cyclosporine or lifitegrast, is lower. She also said patients with psoriasis seem to understand their need for such medications. Dr. Lee recommended patients with psoriasis be seen at least once a year for screening and more often if they present with clinical signs and symptoms with frequency depen- dent on the severity. Dr. Habash, who noted that about 15–20% of her patients who have psoriasis present with ocular surface issues, said in most cases the aim is to quiet down inflammation. She said the goal is also similar with uveitis. Sometimes, Dr. Habash said, reoccurring cases of uveitis can iden- tify psoriasis in a patient who has never had a skin outbreak. "Many times we see patients with recurrent uveitis, and we're the ones who diagnose them using an HLA-B27 test, which can identify patients with psoriatic arthritis. We refer them to a rheumatologist who puts them on an immune mod- ulator, a systemic treatment, and their bouts of uveitis dissipate," Dr. Habash said. In general, Dr. Hammersmith said this study, though on a small sample size, reinforces the impor- tance of considering systemic issues when addressing dry eye disease. "Looking for associated med- ical problems is always helpful in treating patients with dry eye. Even as dry eye specialists, sometimes we're just plugging away at what we do with the eyes and minimize that the eyes are located in the body of people who have other issues," she said. "Some of the patients under report [psoriasis], and if we don't ask them about associated inflammato- ry problems, I think sometimes we miss that connection." EW References 1. Campanati A, et al. Psoriasis beyond the skin: a pilot study on the ocular involvement. Int Ophthalmol. 2015;35:331–40. 2. Aragona E, et al. Tear film and ocular sur- face assessment in psoriasis. Br J Ophthalmol. 2018;102:302–308. Lee: lmarkens@montefiore.org Ozerov: maya.linson@improvingoralhealth.com Editors' note: Dr. Hammersmith has financial interests with Shire (Lexing- ton, Massachusetts). Drs. Habash, Lee, and Ozerov have no financial interests related to their comments. Contact information Habash: ranya@habash.net Hammersmith: khammersmith@willseye.org 973-989-1600 • 800-225-1195 • www.katena.com ® K3-2542 SMILE Spatula K5-5062 Mendez SMILE Forceps SMILE Instruments M e n de z S M I L E P r o ce d u r e Designed by Antonio Mendez, M.D. of Tijuana, Mexico KI-Adv-042817-Rev. 0 Small Incision Lenticule Extraction is quickly gaining popularity with surgeons around the world. The procedure provides unprecedented accuracy in vision correction without the creation of a flap, thereby reducing flap-related and dry eye complications. This double-ended instrument was designed specifically for SMILE procedures. One end features a 3mm long spatula, set at a 45˚ angle, with a blunt conical tip. It is used to identify the wound site and to begin the dissection of the laser created intrastromal tunnel. The opposite end features a beveled disc-shaped distal tip with a flat posterior surface. This end is used to complete the dissection of the tunnel as well as both the anterior and posterior surfaces of the lenticule. Once the lenticule has been completely dissected, the tips of this forceps are used to reach, grasp and remove the tissue. According to Dr. Mendez, "Its atraumatic profile, round front and sides allows for easy access even in 2mm incisions. The large grasping surfaces firmly hold the lenticule without the risk of tearing it. The forceps open side-to-side as to prevent stretching and stress to the cap".

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