EyeWorld India June 2017 Issue

June 2017 EWAP CORNEA 57 In addition to medications, Dr. de Luise will address environmental changes patients can make, such as using a humidifier. The coupling of various therapies does a more effective job at improving the ocular surface, Dr. Yeu said. When she sees intense staining even after treatment, Dr. Yeu will use the PROKERA amniotic membrane (AM; Bio- Tissue, Doral, Florida) or amniotic membrane drops (Ocular Science, Manhattan Beach, Calif.) used off-label. “AM therapy can provide a relatively rapid turnaround on their surface, enough to capture accurate diagnostic measurements for them [after that],” Dr. Yeu said. Many patients with aqueous tear deficiency dry eye will require therapy with an agent like lifitegrast indefinitely because of the chronic progressive nature of dry eye disease, Dr. Holland said. Prior to surgery, dry eye is usually treated for 2 to 4 weeks before patients are reevaluated. “If everything is good, we’re good to go. If not, we need to delay the surgery, which happens rarely,” Dr. Trattler said. Occasionally, a patient’s vision improves so much with the therapies for dry eye that cataract surgery is not necessary at that time, Dr. Trattler said. Still, there are situations where the patient’s ocular surface is not yet ready for surgery upon reevaluation. These patients might have been incompliant with drops or could require punctal plugs or additional therapy, Dr. Trattler said. There are also situations where a patient may want a premium IOL, but the reevaluation reveals they just aren’t a good candidate, Dr. Hovanesian said. “You have to judge if a patient can sustain a good ocular surface before you choose a multifocal IOL for them,” he said. When Dr. Hovanesian has any doubts, he will use a Crystalens (Bausch + Lomb) instead of a mutifocal IOL, as the former tends to be better tolerated. “If dry eye is severe, I’ll consider a toric IOL if we have consistent preoperative measurements for the magnitude and axis of astigmatism. However, I am reluctant to recommend a multifocal IOL in dry eye patients especially if there is an unstable tear film and corneal staining. Dry eye is the most common cause of unhappy multifocal IOL patients,” Dr. Holland said. Because dry eye is a chronic condition, Dr. Hovanesian encourages surgeons to partner with a clinician who has a clinical interest in dry eye management to meet with the patient over time and consistently reevaluate for problems. EWAP Editors’ note: Dr. Holland has financial interests with Allergan, Shire, and TearScience. Dr. Hovanesian has financial interests with Allergan, Bausch + Lomb, Katena (Denville, New Jersey), and Shire. Dr. Trattler has financial interests with Allergan, Bausch + Lomb, Johnson & Johnson (Jacksonville, Florida), and Shire. Dr. Yeu has financial interests with Allergan, BioTissue, Ocular Science, Shire, and TearScience. Dr. de Luise has no financial interests related to this article. Contact information de Luise: vdeluisemd@gmail.com Holland: eholland@holprovision.com Hovanesian: johnhova@gmail.com Trattler: wtrattler@gmail.com Yeu: eyeulin@gmail.com Calendar of Meetings 2017 & 2018 DATE Meeting VENUE July 5-7 39 th Scientific Meeting of the Royal College of Ophthalmologists of Thailand Bangkok Thailand July 16 2017 Korean Society of Cataract & Refractive Surgery meeting (KSCRS) Seoul Korea August 2–5 21 st Annual Meeting of the Australasian Society of Cataract & Refractive Surgeons (AUSCRS) Hamilton Island Australia October 7–11 XXXV Congress of the European Society of Cataract & Refractive Surgeons (ESCRS) Lisbon Portugal December 2–3 4 th INASCRS Biennial meeting Jakarta Indonesia 2018 February 8–11 33 rd Asia-Pacific Academy of Ophthalmology Congress Hong Kong April 13–17 ASCRS-ASOA Symposium and Congress Washington DC U.S. June 16–20 World Ophthalmology Congress 2018 Barcelona Spain June 29–July 1 33 th Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) Tokyo Japan July 19–21 31 st APACRS Annual Meeting Chiang Mai Thailand