EyeWorld India March 2020 Issue

46 EWAP MARCH 2020 CORNEA N ow more than ever, cataract surgery has become a type of refractive surgery, with patients expecting excellent vision postoperatively, especially when they’ve invested in premium IOLs. Yet the presence of dry eye and/or ocular surface disease (OSD) can make this crisp uncorrected vision hard to achieve. “Dry eye and ocular surface disease are an epidemic in our current society,” Marjan Farid, MD, said. “[They’re] multifactorial and related to increased screen time, the environment, hormonal impact, and ocular surgery. Being able to diagnose [dry eye and OSD] help to move the needle to treat these patients, especially because we offer premium cataract surgery now. Patients’ expectations are to have sharp vision, and we can’t have that without a pristine ocular surface.” Although surgeons responding to ASCRS Clinical Surveys have acknowledged the importance of diagnosing and treating dry eye disease (DED), the majority also have said they do not have a uniform way to diagnose and treat DED, Francis Mah, MD, said. In recent years, although other guidelines for DED have been created by the Tear Film and Ocular Surface Society, the American Academy of Ophthalmology, and the CEDARS/ ASPENS group, 1–3 none of these have focused specifically on treating OSD and DED before cataract or refractive surgery, Dr. Mah said. This led the ASCRS Cornea Clinical Committee to create an algorithm for the preop diagnosis and treatment of OSD, published in the May issue of the Journal of Cataract & Refractive Surgery . 4 The one- page algorithm guides users through noninvasive objective refractive and OSD assessments, an evaluation of symptoms via a novel questionnaire, the use of additional tests when available, a brief, directed clinical exam called “Look-Lift-Pull-Push” (LLPP), and targeted treatments before scheduling surgery. “The ASCRS Algorithm is a novel streamlined protocol for integrating OSD identification and management within the context of the standard preoperative refractive surgery patient visit,” Christopher E. Starr, MD, said. “We created it with an emphasis on technician- driven, objective, in-office testing in order to ultimately reduce physician chair time and Algorithm and surgeons address OSD, DED before surgery by Vanessa Caceres EyeWorld Contributing Writer AT A GLANCE • Dry eye and OSD are common problems before cataract and refractive surgery. Addressing these problems can help patients obtain better vision through surgery. • A new algorithm developed by the ASCRS Cornea Clinical Committee addresses the diagnosis and treatment of DED and OSD preoperatively. • The goal of treatment is to have non-visually significant OSD or no OSD present at all preop. • Some patients may require treatment for DED even after surgery. Contact information Ayres: bayres@willseye.org Epitropoulos: eyesmd33@gmail.com Farid: mfarid@uci.edu Mah: mah.francis@scrippshealth.org Starr: cestarr@med.cornell.edu This article originally appeared in the November 2019 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Dry eye inducing irregular astigmatism (over 2 D), topography showing areas of drop out and loss of data (white area) and irregularity of placido rings. After treating DED, more regular topography and regular mires.